Healthcare Provider Details

I. General information

NPI: 1316144041
Provider Name (Legal Business Name): SELAMAWIT NEGUSSE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16100 SAND CANYON AVE STE 130
IRVINE CA
92618-3722
US

IV. Provider business mailing address

16100 SAND CANYON AVE STE 130
IRVINE CA
92618-3722
US

V. Phone/Fax

Practice location:
  • Phone: 949-417-1100
  • Fax: 949-417-1165
Mailing address:
  • Phone: 949-417-1100
  • Fax: 949-417-1165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number25171
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: