Healthcare Provider Details

I. General information

NPI: 1710924295
Provider Name (Legal Business Name): SEGREDO PELSANG & HOUSE ANESTHESIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 STANYAN STREET
SAN FRANCISCO CA
94117
US

IV. Provider business mailing address

PO BOX 7096
STOCKTON CA
95267
US

V. Phone/Fax

Practice location:
  • Phone: 415-668-1000
  • Fax:
Mailing address:
  • Phone: 209-956-7725
  • Fax: 209-956-7733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. ELMA PELSANG
Title or Position: GROUP PRESIDENT
Credential: MD
Phone: 415-668-1000