Organization
SIERRA GASTROENTEROLOGY, PLLC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VIJAYA D BOYELLA MD (PRESIDENT)
(520) 458-5890
Entity
Organization
Contact information
Practice address
4990 E MEDITERRANEAN DR, SUITE A, SIERRA VISTA, AZ 85635-2494
(520) 458-5890
(520) 458-4439
Mailing address
4990 E MEDITERRANEAN DR, SUITE A, SIERRA VISTA, AZ 85635-2494
(520) 458-5890
(520) 458-4439
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
168213
—
AZ
01
—
35086
35086
AZ
Enumeration date
04/23/2012
Last updated
04/23/2012
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