Provider Demographics
NPI:1366496671
Name:SEQUOIA COMMUNITY HEALTH FOUNDATION, INC.
Entity Type:Organization
Organization Name:SEQUOIA COMMUNITY HEALTH FOUNDATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:L
Authorized Official - Last Name:MAFFEO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-487-7806
Mailing Address - Street 1:1945 N FINE AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-1528
Mailing Address - Country:US
Mailing Address - Phone:559-457-5283
Mailing Address - Fax:559-457-5892
Practice Address - Street 1:5784 S ELM AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93706-5813
Practice Address - Country:US
Practice Address - Phone:559-457-5600
Practice Address - Fax:559-457-5690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHAP70880FMedicaid
CAHAP70880FMedicaid
CA551938Medicare Oscar/Certification