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General NPI Number Information
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NPI Number | 1730273830
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Entity Type | Organization
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Legal Business Name | LA MESA OB GYN MEDICAL GROUP INC
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 08/12/2010
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Provider Practice Location Address
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Address Line | 8851 CENTER DR STE 210
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City | LA MESA
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State | CA
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Zip | 91942
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Country | US
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Telephone | 619-463-7775
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Fax | 619-463-4181
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Provider Business Mailing Address
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Address Line | 8851 CENTER DR STE 210
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City | LA MESA
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State | CA
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Zip | 91942
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Country | US
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Telephone | 619-463-7775
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Fax | 619-463-4181
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Authorized Official
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Title or Position | PRESIDENT
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Name | ROBERT S SEGNIT
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Credential | MD
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Telephone | 619-463-7775
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VX0201X
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Taxonomy Name | Gynecologic Oncology Physician
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License Number |
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License Number State |
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