Healthcare Provider Details

I. General information

NPI: 1710075502
Provider Name (Legal Business Name): SARAH J SELA-HERMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 11/29/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 S MAIN ST
ORANGE CA
92868-3835
US

IV. Provider business mailing address

455 S MAIN ST
ORANGE CA
92868-3835
US

V. Phone/Fax

Practice location:
  • Phone: 714-289-4099
  • Fax: 714-516-4299
Mailing address:
  • Phone: 714-289-4511
  • Fax: 714-289-4788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License NumberA54984
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: