Basic Information
| Provider Information | |||||||||
| NPI: | 1982656047 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SEQOIA COMMUNITY HEALTH FOUNDATION, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1945 N FINE AVE | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937271528 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5594575283 | ||||||||
| FaxNumber: | 5594575892 | ||||||||
| Practice Location | |||||||||
| Address1: | 2790 S ELM AVE | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937065435 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5594575200 | ||||||||
| FaxNumber: | 5594575291 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2006 | ||||||||
| LastUpdateDate: | 01/29/2008 | ||||||||
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| AuthorizedOfficialLastName: | MAFFEO | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | L. | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 5594877806 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
ID Information
| ID | Type | State | Issuer | Description | FHC70382F | 05 | CA | MEDICAID | EAP70382F | 05 | CA | MEDICAID | GR0069880 | 05 | CA | MEDICAID |