1558590562 NPI number — MS. BLESILDA AMANO SEGAYA RDHAP

Table of content: MS. BLESILDA AMANO SEGAYA RDHAP (NPI 1558590562)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558590562 NPI number — MS. BLESILDA AMANO SEGAYA RDHAP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SEGAYA
Provider First Name:
BLESILDA
Provider Middle Name:
AMANO
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
RDHAP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SEGAYA
Provider Other First Name:
BLES
Provider Other Middle Name:
AMANO
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RDHAP
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1558590562
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/11/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2807
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHULA VISTA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91912-2807
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-723-2769
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2420 GROVE AVE
Provider Second Line Business Practice Location Address:
SAN DIEGO
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92154-3168
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-723-2769
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/11/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 124Q00000X , with the licence number:  22273 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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