Healthcare Provider Details

I. General information

NPI: 1730273830
Provider Name (Legal Business Name): LA MESA OB GYN MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 08/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8851 CENTER DR STE 210
LA MESA CA
91942
US

IV. Provider business mailing address

8851 CENTER DR STE 210
LA MESA CA
91942
US

V. Phone/Fax

Practice location:
  • Phone: 619-463-7775
  • Fax: 619-463-4181
Mailing address:
  • Phone: 619-463-7775
  • Fax: 619-463-4181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT S SEGNIT
Title or Position: PRESIDENT
Credential: MD
Phone: 619-463-7775