Provider Demographics
NPI:1831231117
Name:SIERRA NEVADA PATHOLOGY MEDICAL GROUP
Entity type:Organization
Organization Name:SIERRA NEVADA PATHOLOGY MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:CUNHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-271-3232
Mailing Address - Street 1:BOX 805
Mailing Address - Street 2:
Mailing Address - City:NEVADA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95959
Mailing Address - Country:US
Mailing Address - Phone:530-271-3232
Mailing Address - Fax:530-271-3239
Practice Address - Street 1:155 GLASSON WAY
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945
Practice Address - Country:US
Practice Address - Phone:530-274-6000
Practice Address - Fax:530-274-6054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG30573246R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246R00000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G305730Medicaid
CAA44471Medicare UPIN