MEDICARE: DR. OLGA SEGAL 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	A85774	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00A857740	OTHER	CA	PIN NUMBER

General Provider Information

NPI Number	:	1821013764
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OLGA SEGAL MD

Provider Business Mailing Address
First Line	:	655 REDWOOD HWY FRONTAGE RD
Second Line	:
City	:	MILL VALLEY
State	:	CA
Zip	:	94941-3055
Country	:	US
Telephone Number	:	707-279-2932
Fax Number	:	707-994-7096

Provider Business Practice Location Address
First Line	:	3455 WESTRIDGE DR
Second Line	:
City	:	KELSEYVILLE
State	:	CA
Zip	:	95451-8227
Country	:	US
Telephone Number	:	707-279-2932
Fax Number	:	707-994-7096

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

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	05/06/2020

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