Healthcare Provider Details

I. General information

NPI: 1609072362
Provider Name (Legal Business Name): ANNEMARIE SELAYA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 WASHINGTON ST STE 600
SAN DIEGO CA
92103-2239
US

IV. Provider business mailing address

501 WASHINGTON ST STE 600
SAN DIEGO CA
92103-2239
US

V. Phone/Fax

Practice location:
  • Phone: 619-278-3350
  • Fax: 619-278-3325
Mailing address:
  • Phone: 619-278-3350
  • Fax: 619-278-3325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA108286
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: