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General NPI Number Information
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NPI Number | 1861015257
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Entity Type | Organization
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Legal Business Name | MICHAEL A SEQUEIRA MD INC
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Dates
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Enumeration Date | 05/20/2020
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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 | 909-477-0316
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Fax |
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Provider Business Mailing 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 | 909-477-0316
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. MICHAEL ANTHONY SEQUEIRA
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Credential | MD
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Telephone | 951-255-2332
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RA0401X
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Taxonomy Name | Addiction Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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