Healthcare Provider Details

I. General information

NPI: 1831605641
Provider Name (Legal Business Name): SEGISMUNDO SENENSE MILLAN IV NP - ADULT GERIATRIC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2017
Last Update Date: 12/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2041 W ORANGEWOOD AVE
ORANGE CA
92868-1944
US

IV. Provider business mailing address

14430 LONGWORTH AVE
NORWALK CA
90650-4721
US

V. Phone/Fax

Practice location:
  • Phone: 714-560-8177
  • Fax:
Mailing address:
  • Phone: 562-413-3918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number95007471
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number95007471
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: