Provider Demographics
NPI:1386274793
Name:GOMILLION, SEQUOIA
Entity type:Individual
Prefix:
First Name:SEQUOIA
Middle Name:
Last Name:GOMILLION
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4660 MARTIN LUTHER KING JR AVE SW APT B201
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20032-4975
Mailing Address - Country:US
Mailing Address - Phone:202-321-8806
Mailing Address - Fax:
Practice Address - Street 1:3066 STANTON RD SE APT 103
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-7889
Practice Address - Country:US
Practice Address - Phone:202-910-6764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-24
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant