Provider Demographics
NPI:1164450458
Name:SEAL, ROBERT (PT)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
Last Name:SEAL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 TOWNSITE DR
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92084-5566
Mailing Address - Country:US
Mailing Address - Phone:760-630-2422
Mailing Address - Fax:
Practice Address - Street 1:840 TOWNSITE DR
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92084-5566
Practice Address - Country:US
Practice Address - Phone:760-630-2422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT8559174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT8559OtherPT LICNESE