Healthcare Provider Details

I. General information

NPI: 1578230793
Provider Name (Legal Business Name): SARABENET SEQUEIRA, MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2021
Last Update Date: 01/19/2022
Certification Date: 01/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 CAMINO ALTO STE 4
MILL VALLEY CA
94941-2219
US

IV. Provider business mailing address

141 CAMINO ALTO STE 4
MILL VALLEY CA
94941-2219
US

V. Phone/Fax

Practice location:
  • Phone: 415-518-9354
  • Fax:
Mailing address:
  • Phone: 415-634-1004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SARABENET SEQUEIRA
Title or Position: CEO
Credential: MD
Phone: 415-518-9354