Healthcare Provider Details

I. General information

NPI: 1154388650
Provider Name (Legal Business Name): HOUSHANG SEMINO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17215 N 72ND DR D-140A
GLENDALE AZ
85308-8558
US

IV. Provider business mailing address

11638 N 12TH PL
PHOENIX AZ
85020-1221
US

V. Phone/Fax

Practice location:
  • Phone: 623-487-9630
  • Fax: 623-487-9631
Mailing address:
  • Phone: 602-390-2496
  • Fax: 602-293-3236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number10751
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: