Healthcare Provider Details

I. General information

NPI: 1043462856
Provider Name (Legal Business Name): ROGER W SEWARD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2008
Last Update Date: 10/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14411 VANOWEN ST
VAN NUYS CA
91405-4038
US

IV. Provider business mailing address

11000 MORRISON ST APT 205
NORTH HOLLYWOOD CA
91601-5604
US

V. Phone/Fax

Practice location:
  • Phone: 818-989-7475
  • Fax: 818-781-3822
Mailing address:
  • Phone: 818-588-2059
  • Fax: 818-781-3822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: