Healthcare Provider Details

I. General information

NPI: 1134625460
Provider Name (Legal Business Name): ANN SEELEY MACQUARRIE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANN ELIZABETH SEELEY MD

II. Dates (important events)

Enumeration Date: 04/04/2018
Last Update Date: 08/23/2022
Certification Date: 08/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3811 VALLEY CENTRE DR
SAN DIEGO CA
92130-3318
US

IV. Provider business mailing address

3020 CHILDRENS WAY # MC5124
SAN DIEGO CA
92123-4223
US

V. Phone/Fax

Practice location:
  • Phone: 858-764-3040
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA165236
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: