Healthcare Provider Details

I. General information

NPI: 1053159897
Provider Name (Legal Business Name): SEAN EMMANUEL STEPHANE COECKELENBERGH MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2024
Last Update Date: 09/04/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 THE CITY DR S
ORANGE CA
92868-3201
US

IV. Provider business mailing address

101 THE CITY DR SOUTH BLDG. 53 RM. 227 RT 81A
ORANGE CA
92868
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-8744
  • Fax:
Mailing address:
  • Phone: 714-456-8744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberSPI833
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: