Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | G64724 | CA |
N | 207QA0401X | Family Doctor - Addiction Medicine | G64724 | CA |
NPI | 1578512844 |
---|---|
Provider Name | Michael Anthony Sequeira |
First Address | Redlands, CA 92373-6832 |
Second Address | Claremont, CA 91711-2762 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2006 |
Last Update Date | 20/05/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C93745 | (02) | CA |