MEDICARE: DR. HOUSHANG SEMINO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	10751	AZ

General Provider Information

NPI Number	:	1154388650
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HOUSHANG SEMINO MD

Provider Business Mailing Address
First Line	:	11638 N 12TH PL
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85020-1221
Country	:	US
Telephone Number	:	602-390-2496
Fax Number	:	602-293-3236

Provider Business Practice Location Address
First Line	:	17215 N 72ND DR
Second Line	:	D-140A
City	:	GLENDALE
State	:	AZ
Zip	:	85308-8558
Country	:	US
Telephone Number	:	623-487-9630
Fax Number	:	623-487-9631

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/27/2006
Last Update Date	:	07/08/2007

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