Basic Information
| Provider Information | |||||||||
| NPI: | 1679506018 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SEDER | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2320 BATH ST STE 208 | ||||||||
| Address2: | |||||||||
| City: | SANTA BARBARA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 931055322 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8056827984 | ||||||||
| FaxNumber: | 8056823321 | ||||||||
| Practice Location | |||||||||
| Address1: | 147 N BRENT ST | ||||||||
| Address2: | |||||||||
| City: | VENTURA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930032809 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8056827744 | ||||||||
| FaxNumber: | 8056823321 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2006 | ||||||||
| LastUpdateDate: | 03/07/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207U00000X | G29912 | CA | Y | Allopathic & Osteopathic Physicians | Nuclear Medicine | 207R00000X | G29912 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00G29912 0 | 01 | CA | BS OF CA | OTHER | 00G299120 | 01 | CA | BLUE SHIELD | OTHER | 1679506018 | 05 | CA | MEDICAID | 00G299121 | 05 | CA | MEDICAID | 005299121 | 05 | CA | MEDICAID |