Healthcare Provider Details

I. General information

NPI: 1568436350
Provider Name (Legal Business Name): GILBERT SEDA JR. M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2006
Last Update Date: 12/27/2022
Certification Date: 12/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 H ST
CHULA VISTA CA
91910-4307
US

IV. Provider business mailing address

4635 MAYAPAN DR
LA MESA CA
91941-7147
US

V. Phone/Fax

Practice location:
  • Phone: 619-691-7360
  • Fax: 619-691-7306
Mailing address:
  • Phone: 619-248-2758
  • Fax: 619-691-7306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number25052
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2020
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number0101238558
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number0101238558
License Number StateVA
# 5
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberC156208
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberC156208
License Number StateCA
# 7
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberC156208
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: