Provider Demographics
NPI:1730268475
Name:SEQUOIA MOBILITY SUPPLY
Entity type:Organization
Organization Name:SEQUOIA MOBILITY SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:FABIAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:AGUILAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-734-4052
Mailing Address - Street 1:3749 S MOONEY BLVD
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-8000
Mailing Address - Country:US
Mailing Address - Phone:559-734-4052
Mailing Address - Fax:559-734-9586
Practice Address - Street 1:3749 S MOONEY BLVD
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-8000
Practice Address - Country:US
Practice Address - Phone:559-734-4052
Practice Address - Fax:559-734-9586
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SEQUOIA MOBILITY SUPPLY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-03
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CABL021745332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5865640001Medicare NSC