Provider Demographics
NPI:1568436350
Name:SEDA, GILBERT JR (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:GILBERT
Middle Name:
Last Name:SEDA
Suffix:JR
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4635 MAYAPAN DR
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91941-7147
Mailing Address - Country:US
Mailing Address - Phone:619-248-2758
Mailing Address - Fax:619-691-7306
Practice Address - Street 1:435 H ST
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-4307
Practice Address - Country:US
Practice Address - Phone:619-691-7360
Practice Address - Fax:619-691-7306
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25052103TC0700X
NC2020103TC0700X
VA0101238558207RC0200X, 207RP1001X
CAC156208207RP1001X, 207RS0012X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1568436350Medicaid