Healthcare Provider Details

I. General information

NPI: 1073605473
Provider Name (Legal Business Name): JERALD FREDRICK SIGALA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 12/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 SUPERIOR AVE SUITE 340
NEWPORT BEACH CA
92663-3637
US

IV. Provider business mailing address

1310 W STEWART DR SUITE 607
ORANGE CA
92868-3854
US

V. Phone/Fax

Practice location:
  • Phone: 949-631-9215
  • Fax: 949-631-4576
Mailing address:
  • Phone: 714-639-4901
  • Fax: 714-771-5389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberG33210
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: