Healthcare Provider Details

I. General information

NPI: 1700571114
Provider Name (Legal Business Name): PRATIBHA SEHGAL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2023
Last Update Date: 04/11/2023
Certification Date: 04/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1621 ANGORA WAY
PALMDALE CA
93551-4374
US

IV. Provider business mailing address

1621 ANGORA WAY
PALMDALE CA
93551-4374
US

V. Phone/Fax

Practice location:
  • Phone: 661-406-4870
  • Fax:
Mailing address:
  • Phone: 661-406-4870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number98024383
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number95024383
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number95024383
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: