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General NPI Number Information
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NPI Number | 1194180182
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Entity Type | Individual
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Provider Name | STEVEN SECREST
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Gender | Male
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Dates
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Enumeration Date | 12/18/2015
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Last Update Date | 12/18/2015
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Provider Practice Location Address
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Address Line | 3206 COLORADO PL
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City | COSTA MESA
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State | CA
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Zip | 92626-2233
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Country | US
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Telephone | 714-697-3369
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Fax |
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Provider Business Mailing Address
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Address Line | 3206 COLORADO PL
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City | COSTA MESA
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State | CA
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Zip | 92626-2233
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Country | US
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Telephone | 714-697-3369
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2471N0900X
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Taxonomy Name | Nuclear Medicine Technology Radiologic Technologist
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License Number | RHN2685
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License Number State | CA
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