Healthcare Provider Details

I. General information

NPI: 1457307761
Provider Name (Legal Business Name): MARC A SEFTEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 01/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 WATER ST STE A
SANTA CRUZ CA
95060-4126
US

IV. Provider business mailing address

550 WATER ST STE A
SANTA CRUZ CA
95060-4126
US

V. Phone/Fax

Practice location:
  • Phone: 831-476-4414
  • Fax: 831-476-0264
Mailing address:
  • Phone: 831-476-4414
  • Fax: 831-476-0264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA44368
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License NumberA44368
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207YS0012X
TaxonomySleep Medicine (Otolaryngology) Physician
License NumberA44368
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License NumberA44368
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License NumberA44368
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: