Healthcare Provider Details

I. General information

NPI: 1376800375
Provider Name (Legal Business Name): SARAH KAY SELAG HERRERA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARAH KAY SELAG-HERRERA M.D.

II. Dates (important events)

Enumeration Date: 04/13/2012
Last Update Date: 10/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23521 PASEO DE VALENCIA SUITE 200
LAGUNA HILLS CA
92653-3107
US

IV. Provider business mailing address

23521 PASEO DE VALENCIA SUITE 200
LAGUNA HILLS CA
92653-3107
US

V. Phone/Fax

Practice location:
  • Phone: 949-951-5437
  • Fax:
Mailing address:
  • Phone: 949-951-5437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA128825
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: