Healthcare Provider Details

I. General information

NPI: 1982656047
Provider Name (Legal Business Name): SEQOIA COMMUNITY HEALTH FOUNDATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 01/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2790 S ELM AVE
FRESNO CA
93706-5435
US

IV. Provider business mailing address

1945 N FINE AVE
FRESNO CA
93727-1528
US

V. Phone/Fax

Practice location:
  • Phone: 559-457-5200
  • Fax: 559-457-5291
Mailing address:
  • Phone: 559-457-5283
  • Fax: 559-457-5892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number StateCA

VIII. Authorized Official

Name: DR. JOHN L. MAFFEO
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: M.D.
Phone: 559-487-7806