Healthcare Provider Details

I. General information

NPI: 1437837879
Provider Name (Legal Business Name): DOUGLAS MARTIN SIEGMUND FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2023
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 E 1ST ST STE 100
SANTA ANA CA
92705-4086
US

IV. Provider business mailing address

2915 N. COTTONWOOD ST. UNIT 18
ORANGE CA
92865
US

V. Phone/Fax

Practice location:
  • Phone: 714-556-7246
  • Fax:
Mailing address:
  • Phone: 714-342-8684
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95025832
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95128967
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: