1356398416 NPI number — SEQUOIA HEALTH SERVICES

Table of content: (NPI 1356398416)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356398416 NPI number — SEQUOIA HEALTH SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SEQUOIA HEALTH SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356398416
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/02/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1825 S GRANT ST
Provider Second Line Business Mailing Address:
SUITE 900
Provider Business Mailing Address City Name:
SAN MATEO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94402-2655
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
650-817-3181
Provider Business Mailing Address Fax Number:
650-482-3592

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
633 VETERANS BLVD
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
REDWOOD CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94063-1408
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-364-1565
Provider Business Practice Location Address Fax Number:
650-366-2590
Provider Enumeration Date:
05/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BARTON
Authorized Official First Name:
GRATIA
Authorized Official Middle Name:
Authorized Official Title or Position:
VP CFO
Authorized Official Telephone Number:
650-367-5837

Provider Taxonomy Codes

  • Taxonomy code: 261QX0100X , with the licence number:  220000045 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 104617500 . This is a "DOFL - PALO ALTO LOC" identifier . This identifiers is of the category "OTHER".
  • Identifier: G53480 . This is a "DOFL - REDWOOD CITY LOC" identifier . This identifiers is of the category "OTHER".




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