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General NPI Number Information
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NPI Number | 1740498047
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Entity Type | Organization
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Legal Business Name | SEQUOIA SURGICAL SPECIALISTS MEDICAL GROUP, INC
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Dates
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Enumeration Date | 05/18/2007
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Last Update Date | 03/03/2011
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Provider Practice Location Address
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Address Line | 125 MALL DR 201
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City | HANFORD
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State | CA
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Zip | 93230-5787
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Country | US
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Telephone | 559-584-2695
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Fax | 559-584-2697
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Provider Business Mailing Address
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Address Line | 125 MALL DR 201
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City | HANFORD
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State | CA
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Zip | 93230-5787
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Country | US
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Telephone | 559-584-2695
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Fax | 559-584-2697
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Authorized Official
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Title or Position | OWNER
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Name | EDYTHE W STEWART
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Credential | MD
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Telephone | 559-584-2695
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A65931
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License Number State | CA
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