Organization Active NPI

Sierra San Antonio Medical Corporation

  • Family Medicine Physician
  • Fontana, CA
National Provider Identifier
1790711562
Registry record updated May 21, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
SIERRA SAN ANTONIO MEDICAL CORPORATION
Practice address
16465 Sierra Lakes Parkway
Suite 100
Fontana, CA 92336
Phone
(909) 434-1150
Fax
(909) 434-1166
NPI assigned
Jun 24, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 21, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Olivia Marie Bajor, D.O.NPI 1972544880
Title
Vice President
Phone
(909) 434-1150

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

16465 Sierra Lakes Parkway
Suite 100
Fontana, CA 92336

Mailing address

16465 Sierra Lakes Parkway
Suite 100
Fontana, CA 92336
Phone (909) 434-1150

Other names 1

  • Sierra San Antonio Urgent Care Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D1052972San Antonio Urgent Care16465 Sierra Lakes Pkway, Ste 100, Fontana, CA 92336Certificate of waiverJun 3, 2027

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151107200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1211328000000",
    "number": "1790711562",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16465 SIERRA LAKES PARKWAY",
            "address_2": "SUITE 100",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "92336",
            "telephone_number": "909-434-1150",
            "fax_number": "909-434-1166"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16465 SIERRA LAKES PARKWAY",
            "address_2": "SUITE 100",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "92336",
            "telephone_number": "909-434-1150",
            "fax_number": "909-434-1166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SIERRA SAN ANTONIO MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-24",
        "last_updated": "2008-05-21",
        "status": "A",
        "authorized_official_last_name": "BAJOR",
        "authorized_official_first_name": "OLIVIA",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "909-434-1150",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sierra San Antonio Urgent Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fontana, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.