Healthcare Provider Details

I. General information

NPI: 1801590450
Provider Name (Legal Business Name): HENRY SESAY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2023
Last Update Date: 08/01/2023
Certification Date: 08/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 S STATE COLLEGE BLVD
ANAHEIM CA
92806-2921
US

IV. Provider business mailing address

6241 WARNER AVE SPC 127
HUNTINGTON BEACH CA
92647-5150
US

V. Phone/Fax

Practice location:
  • Phone: 714-778-2519
  • Fax:
Mailing address:
  • Phone: 571-485-1328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number725903
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: