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General NPI Number Information
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NPI Number | 1578512844
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Entity Type | Individual
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Provider Name | MICHAEL ANTHONY SEQUEIRA M.D
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Gender | Male
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Dates
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Enumeration Date | 05/06/2006
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Last Update Date | 05/20/2020
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Provider Practice Location Address
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Address Line | 458 POTOMAC WAY
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City | CLAREMONT
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State | CA
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Zip | 91711-2762
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Country | US
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Telephone | 909-447-0316
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Fax | 909-447-0316
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Provider Business Mailing Address
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Address Line | 210 CAMPBELL AVE
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City | REDLANDS
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State | CA
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Zip | 92373-6832
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number | G64724
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | G64724
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License Number State | CA
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