Basic Information
| Provider Information | |||||||||
| NPI: | 1528016987 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SEQUOIA FAMILY MEDICAL CENTER, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 590 W PUTNAM AVE | ||||||||
| Address2: | SUITE 2A | ||||||||
| City: | PORTERVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932573257 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5597814100 | ||||||||
| FaxNumber: | 5597814350 | ||||||||
| Practice Location | |||||||||
| Address1: | 590 W PUTNAM AVE | ||||||||
| Address2: | SUITE 2A | ||||||||
| City: | PORTERVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932573257 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5597814100 | ||||||||
| FaxNumber: | 5597814350 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2006 | ||||||||
| LastUpdateDate: | 11/19/2010 | ||||||||
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| AuthorizedOfficialLastName: | GILES | ||||||||
| AuthorizedOfficialFirstName: | JANET | ||||||||
| AuthorizedOfficialMiddleName: | F | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 5597814100 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | RHM53820F | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
ID Information
| ID | Type | State | Issuer | Description | RHM53820F | 05 | CA | MEDICAID |