Healthcare Provider Details

I. General information

NPI: 1295463263
Provider Name (Legal Business Name): SAN BERNARDINO COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2022
Last Update Date: 08/22/2024
Certification Date: 08/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 W. MAPLE ST.
ONTARIO CA
91762-5734
US

IV. Provider business mailing address

451 E VANDERBILT WAY STE 400
SAN BERNARDINO CA
92408-3614
US

V. Phone/Fax

Practice location:
  • Phone: 800-722-4777
  • Fax:
Mailing address:
  • Phone: 909-387-6218
  • Fax: 909-387-6228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL A. SEQUEIRA
Title or Position: HEALTH OFFICER
Credential: MD
Phone: 909-387-6218