Provider Demographics
NPI:1851821565
Name:SEQUOIA HEALTH IPA INC
Entity Type:Organization
Organization Name:SEQUOIA HEALTH IPA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR DIRECTOR, PROGRAM DEV & PLANNING
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:KLAREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-510-6016
Mailing Address - Street 1:2115 COMPTON AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92881-7272
Mailing Address - Country:US
Mailing Address - Phone:951-280-7700
Mailing Address - Fax:
Practice Address - Street 1:2115 COMPTON AVE STE 301
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92881-7272
Practice Address - Country:US
Practice Address - Phone:951-280-7700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization