Provider Demographics
NPI:1588834451
Name:COUNTY OF SAN BERNARDINO
Entity type:Organization
Organization Name:COUNTY OF SAN BERNARDINO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:SEQUEIRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-387-6218
Mailing Address - Street 1:451 E VANDERBILT WAY STE 400
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-3614
Mailing Address - Country:US
Mailing Address - Phone:909-387-6218
Mailing Address - Fax:909-387-6228
Practice Address - Street 1:150 E HOLT AVE
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91761
Practice Address - Country:US
Practice Address - Phone:909-458-9447
Practice Address - Fax:909-986-7814
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF SAN BERNARDINO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-07
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALAB65059FOtherLAB
CAZZT11488FMedicaid
CAZZZ75903ZMedicare UPIN