Healthcare Provider Details

I. General information

NPI: 1679780381
Provider Name (Legal Business Name): SEQUENT CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 07/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10520 S EASTERN AVE #100
HENDERSON NV
89052-3900
US

IV. Provider business mailing address

10520 S EASTERN AVE #100
HENDERSON NV
89052-3900
US

V. Phone/Fax

Practice location:
  • Phone: 702-838-8111
  • Fax: 702-838-8115
Mailing address:
  • Phone: 702-838-8111
  • Fax: 702-838-8115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberMP00225
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberMP00225
License Number StateNV

VIII. Authorized Official

Name: DEWITT J PAUL
Title or Position: PRESIDENT
Credential: C.PED
Phone: 714-222-7095