Provider Demographics
NPI:1548325004
Name:SIERRA VISTA HOSPITAL
Entity type:Organization
Organization Name:SIERRA VISTA HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:ANANTH
Authorized Official - Middle Name:
Authorized Official - Last Name:SHANMUGAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-452-6682
Mailing Address - Street 1:3108 FULTON AVE
Mailing Address - Street 2:STE 2
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95821
Mailing Address - Country:US
Mailing Address - Phone:916-452-6682
Mailing Address - Fax:916-452-6683
Practice Address - Street 1:8250 CALVINE RD
Practice Address - Street 2:STE C165
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95828
Practice Address - Country:US
Practice Address - Phone:916-452-6682
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA9057902084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A905790Medicaid
00A905790Medicare ID - Type Unspecified