MEDICARE: SEQUOIA COMMUNITY HEALTH FOUNDATION, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QF0400X	Federally Qualified Health Center (FQHC)		CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194852566
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEQUOIA COMMUNITY HEALTH FOUNDATION, INC

Provider Business Mailing Address
First Line	:	1945 N FINE AVE STE 116
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93727-1528
Country	:	US
Telephone Number	:	559-457-5800
Fax Number	:	559-457-5891

Provider Business Practice Location Address
First Line	:	5784 S ELM AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93706-5813
Country	:	US
Telephone Number	:	559-457-5600
Fax Number	:	559-457-5690

Authorized Official
Title or Position	:	CEO
Name	:	JOHN L MAFFEO
Credential	:	MD
Telephone Number	:	559-457-5239

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	08/22/2020

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