Organization
SIERRA ORTHOPEDIC LABORATORY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID JOHN JEFFRIES C.O. (OWNER)
(707) 528-9808
Entity
Organization
Contact information
Practice address
4847 OLD REDWOOD HWY, SANTA ROSA, CA 95403-1415
(707) 528-9808
(707) 528-9818
Mailing address
4847 OLD REDWOOD HWY, SANTA ROSA, CA 95403-1415
(707) 528-9808
(707) 528-9818
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
CMS162587
—
CA
05
—
GFC000230
—
CA
Enumeration date
09/13/2005
Last updated
03/18/2014
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