Healthcare Provider Details

I. General information

NPI: 1134181597
Provider Name (Legal Business Name): EDWARD ALLEN SIEGEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 HILL ST
SOLANA BEACH CA
92075-1141
US

IV. Provider business mailing address

255 HILL ST
SOLANA BEACH CA
92075-1141
US

V. Phone/Fax

Practice location:
  • Phone: 858-755-0316
  • Fax: 858-755-0316
Mailing address:
  • Phone: 858-755-0316
  • Fax: 858-755-0316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberC35518
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: