Provider Demographics
NPI:1538258827
Name:SEQUEIRA, RITA MARIE (PHD)
Entity type:Individual
Prefix:DR
First Name:RITA
Middle Name:MARIE
Last Name:SEQUEIRA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2220 E FRUIT ST
Mailing Address - Street 2:SUITE 109
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701-4459
Mailing Address - Country:US
Mailing Address - Phone:714-541-8255
Mailing Address - Fax:714-541-8256
Practice Address - Street 1:2220 E FRUIT ST
Practice Address - Street 2:SUITE 109
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-4459
Practice Address - Country:US
Practice Address - Phone:714-541-8255
Practice Address - Fax:714-541-8256
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16167103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical