MEDICARE: ENID L SEAL

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	174400000X	Specialist	SR EAA99941141	CA

General Provider Information

NPI Number	:	1831255025
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ENID L SEAL

Provider Business Mailing Address
First Line	:	27601 FORBES RD
Second Line	:	SUITE 24
City	:	LAGUNA NIGUEL
State	:	CA
Zip	:	92677-1201
Country	:	US
Telephone Number	:	949-582-9210
Fax Number	:	949-582-9280

Provider Business Practice Location Address
First Line	:	27601 FORBES RD
Second Line	:	SUITE 24
City	:	LAGUNA NIGUEL
State	:	CA
Zip	:	92677-1201
Country	:	US
Telephone Number	:	949-582-9210
Fax Number	:	949-582-9280

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

Provider Enumeration Date	:	12/29/2006
Last Update Date	:	07/08/2007

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