Healthcare Provider Details

I. General information

NPI: 1457556581
Provider Name (Legal Business Name): CLIFFORD SEGIL D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 12/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 SANTA MONICA BLVD 860
SANTA MONICA CA
90404-2102
US

IV. Provider business mailing address

6029 BRISTOL PKWY STE 100
CULVER CITY CA
90230-4899
US

V. Phone/Fax

Practice location:
  • Phone: 310-828-3209
  • Fax: 310-828-5165
Mailing address:
  • Phone: 310-417-5900
  • Fax: 310-410-1001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number20A9399
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: