Healthcare Provider Details

I. General information

NPI: 1104027481
Provider Name (Legal Business Name): CLIVE M. SEGIL, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 CENTURY PARK E SUITE 500
LOS ANGELES CA
90067-2001
US

IV. Provider business mailing address

2080 CENTURY PARK E SUITE 500
LOS ANGELES CA
90067-2001
US

V. Phone/Fax

Practice location:
  • Phone: 310-203-5490
  • Fax: 310-203-5412
Mailing address:
  • Phone: 310-203-5490
  • Fax: 310-203-5412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License NumberA26735
License Number StateCA

VIII. Authorized Official

Name: DR. CLIVE M SEGIL
Title or Position: CEO
Credential: M.D.
Phone: 310-203-5490