Basic Information
| Provider Information | |||||||||
| NPI: | 1629175948 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SEYDEL & SANCHEZ GENERAL SURGERY, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 754 MEDICAL CENTER CT STE 203 | ||||||||
| Address2: | |||||||||
| City: | CHULA VISTA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919116656 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6196566493 | ||||||||
| FaxNumber: | 6196565727 | ||||||||
| Practice Location | |||||||||
| Address1: | 754 MEDICAL CENTER CT # 203 | ||||||||
| Address2: | |||||||||
| City: | CHULA VISTA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91911 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6196566493 | ||||||||
| FaxNumber: | 6196565727 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | SANCHEZ | ||||||||
| AuthorizedOfficialFirstName: | EDWARD | ||||||||
| AuthorizedOfficialMiddleName: | RUBEN | ||||||||
| AuthorizedOfficialTitleorPosition: | VICE-PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6196566493 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM2500X | Y | Ambulatory Health Care Facilities | Clinic/Center | Medical Specialty |
ID Information
| ID | Type | State | Issuer | Description | 00G136440 | 05 | CA | MEDICAID |