Healthcare Provider Details

I. General information

NPI: 1194799163
Provider Name (Legal Business Name): MELVIN O SENAC JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 10/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8745 AERO DRIVE SUITE 200
SAN DIEGO CA
92123-1774
US

IV. Provider business mailing address

PO BOX 23540
SAN DIEGO CA
92123-3540
US

V. Phone/Fax

Practice location:
  • Phone: 858-565-0950
  • Fax: 858-244-1100
Mailing address:
  • Phone: 858-565-0950
  • Fax: 858-244-1100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License NumberG40027
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberG40027
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License NumberG40027
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License NumberG40027
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberG40027
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License NumberG40027
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: