Provider Demographics
NPI:1275180747
Name:SEQUEIRA, ERICA MICHELLE
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:MICHELLE
Last Name:SEQUEIRA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 E GRAND AVE APT 1111
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92027-3166
Mailing Address - Country:US
Mailing Address - Phone:415-596-1368
Mailing Address - Fax:
Practice Address - Street 1:1940 LEVANTE ST
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92009-5174
Practice Address - Country:US
Practice Address - Phone:800-852-4384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-20
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20118225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist