Provider Demographics
NPI:1265405328
Name:SEQUOIA ONCOLOGY MEDICAL ASSOC
Entity type:Organization
Organization Name:SEQUOIA ONCOLOGY MEDICAL ASSOC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:HAVARD
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:559-624-3000
Mailing Address - Street 1:4945 W CYPRESS AVE
Mailing Address - Street 2:STE C
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277
Mailing Address - Country:US
Mailing Address - Phone:559-624-3000
Mailing Address - Fax:559-635-4006
Practice Address - Street 1:4945 W CYPRESS AVE
Practice Address - Street 2:STE C
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277
Practice Address - Country:US
Practice Address - Phone:559-624-3000
Practice Address - Fax:559-635-4006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-09
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ24063ZMedicare ID - Type Unspecified
CA6324330001Medicare NSC