Edgardo A Sequeira, LSA, CSFA

Primary specialty

Surgical AssistantTaxonomy code 246ZC0007X

License

SA00736 Issued in TX

Practice address

121 Tuscany Dr
Georgetown, TX 78628-7066

Phone

(818) 471-5979

NPI assigned

Aug 16, 2019

Last updated

Aug 16, 2019By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1565913600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1565913600000",
    "number": "1356997118",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "121 TUSCANY DR",
            "city": "GEORGETOWN",
            "state": "TX",
            "postal_code": "786287066",
            "telephone_number": "818-471-5979"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 TUSCANY DR",
            "city": "GEORGETOWN",
            "state": "TX",
            "postal_code": "786287066",
            "telephone_number": "818-471-5979"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SEQUEIRA",
        "first_name": "EDGARDO",
        "middle_name": "A",
        "credential": "LSA, CSFA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-08-16",
        "last_updated": "2019-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "246ZC0007X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other, Surgical Assistant",
            "state": "TX",
            "license": "SA00736",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NATIONAL BOARD OF SURGICAL TECHNOLOGY AND SURGICAL ASSISTING",
            "identifier": "178570",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SURGICAL ASSISTANT LICENSE",
            "identifier": "SA00736",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Surgical Assistant in Georgetown, TX
• Providers in Georgetown, TX by specialty
• Surgical Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.