MEDICARE: SEQUOIA WELLNESS LLC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1477253011
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEQUOIA WELLNESS LLC

Provider Business Mailing Address
First Line	:	1414 W BROADWAY RD STE 145
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85282-1142
Country	:	US
Telephone Number	:	786-377-4925
Fax Number	:

Provider Business Practice Location Address
First Line	:	1414 W BROADWAY RD STE 127
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85282-1121
Country	:	US
Telephone Number	:	786-377-4925
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	BRIAN KAROW
Credential	:
Telephone Number	:	786-377-4925

Provider Enumeration Date	:	03/02/2023
Last Update Date	:	01/17/2024

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Directions to “SEQUOIA WELLNESS LLC ” Practice Location

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