Provider Demographics
NPI:1043373194
Name:NEIRA, SERGIO O (MD)
Entity Type:Individual
Prefix:
First Name:SERGIO
Middle Name:O
Last Name:NEIRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 OUTLET CENTER DR STE 200
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036-0666
Mailing Address - Country:US
Mailing Address - Phone:805-981-8300
Mailing Address - Fax:805-981-8302
Practice Address - Street 1:1901 OUTLET CENTER DR STE 200
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-0666
Practice Address - Country:US
Practice Address - Phone:805-981-8300
Practice Address - Fax:805-981-8302
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA38228207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW14868Medicare ID - Type Unspecified
CAA85113Medicare UPIN