Provider Demographics
NPI:1194371849
Name:SEQUOIA HEALTHCARE ALLIANCE
Entity Type:Organization
Organization Name:SEQUOIA HEALTHCARE ALLIANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:ANGELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-388-1588
Mailing Address - Street 1:590 W PUTNAM AVE STE 11
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-3257
Mailing Address - Country:US
Mailing Address - Phone:559-781-4100
Mailing Address - Fax:
Practice Address - Street 1:585 W PUTNAM AVE
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-3270
Practice Address - Country:US
Practice Address - Phone:559-781-1665
Practice Address - Fax:559-781-6036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-16
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty