Healthcare Provider Details

I. General information

NPI: 1669732772
Provider Name (Legal Business Name): PEDIATRIC ALTERNATIVES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2012
Last Update Date: 05/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 THOMAS DR
MILL VALLEY CA
94941-1615
US

IV. Provider business mailing address

10 THOMAS DR
MILL VALLEY CA
94941-1615
US

V. Phone/Fax

Practice location:
  • Phone: 415-380-8448
  • Fax:
Mailing address:
  • Phone: 415-380-8448
  • 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: PARTNER
Credential: M.D.
Phone: 415-380-8448