Healthcare Provider Details

I. General information

NPI: 1689064388
Provider Name (Legal Business Name): NICOLE AFIF SENA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2015
Last Update Date: 05/28/2023
Certification Date: 05/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 LENNON LN
WALNUT CREEK CA
94598-2419
US

IV. Provider business mailing address

5565 W LAS POSITAS BLVD STE 240
PLEASANTON CA
94588-5807
US

V. Phone/Fax

Practice location:
  • Phone: 925-906-2000
  • Fax:
Mailing address:
  • Phone: 925-460-8444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberNA
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: