Provider Demographics
NPI:1033825989
Name:SEIDL, ERIC E
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:E
Last Name:SEIDL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2549 EASTBLUFF DR STE A
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-3512
Mailing Address - Country:US
Mailing Address - Phone:714-486-6866
Mailing Address - Fax:
Practice Address - Street 1:1000 QUAIL ST STE 160
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2721
Practice Address - Country:US
Practice Address - Phone:714-486-6866
Practice Address - Fax:949-274-8925
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-24
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA72216225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist