Provider Demographics
NPI:1891033668
Name:SEQUOIA FAMILY MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:SEQUOIA FAMILY MEDICAL GROUP, INC.
Other - Org Name:PACIFIC PAIN & JOINT CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:STUART
Authorized Official - Last Name:WILBUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-479-8546
Mailing Address - Street 1:12672 LIMONITE AVE.
Mailing Address - Street 2:SUITE 3E-235
Mailing Address - City:EASTVALE
Mailing Address - State:CA
Mailing Address - Zip Code:92880-4208
Mailing Address - Country:US
Mailing Address - Phone:951-479-8546
Mailing Address - Fax:
Practice Address - Street 1:4024 12TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-3561
Practice Address - Country:US
Practice Address - Phone:951-683-0300
Practice Address - Fax:951-683-0310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-29
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty