Provider Demographics
NPI:1295463263
Name:SAN BERNARDINO COUNTY
Entity type:Organization
Organization Name:SAN BERNARDINO COUNTY
Other - Org Name:<UNAVAIL>
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 1:555 W. MAPLE ST.
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762-5734
Practice Address - Country:US
Practice Address - Phone:800-722-4777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAN BERNARDINO COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-08-09
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare