Provider Demographics
NPI:1013014448
Name:SEGERSTROM, HUNTINGTON (PA-C)
Entity Type:Individual
Prefix:
First Name:HUNTINGTON
Middle Name:
Last Name:SEGERSTROM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 50648
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93150-0648
Mailing Address - Country:US
Mailing Address - Phone:530-575-7946
Mailing Address - Fax:
Practice Address - Street 1:721 CLIFF DR
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93109-2312
Practice Address - Country:US
Practice Address - Phone:530-575-7946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15208363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA15208OtherPA LICENSE NUMBER