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NPI Code Detail

MEDICARE: PAUL SEQUEIRA

MEDICARE: PAUL SEQUEIRA
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1942583349
Entity Type Code : Individual
Provider Name (Legal Business Name) : PAUL SEQUEIRA
Provider Business Mailing Address
First Line : 3587 HEATHROW WAY
Second Line :
City : MEDFORD
State : OR
Zip : 97504-4004
Country : US
Telephone Number : 541-858-8170
Fax Number :
Provider Business Practice Location Address
First Line : 3200 JUANIPERO WAY
Second Line :
City : MEDFORD
State : OR
Zip : 97504-8580
Country : US
Telephone Number : 541-816-4131
Fax Number : 458-226-2163
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/21/2011
Last Update Date : 03/19/2020

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Directions to “ PAUL SEQUEIRA ” Practice Location

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