Provider Demographics
NPI:1619916913
Name:SEGAL, JEANETT (MD)
Entity Type:Individual
Prefix:
First Name:JEANETT
Middle Name:
Last Name:SEGAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44215 15TH ST W
Mailing Address - Street 2:STE 209
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-5504
Mailing Address - Country:US
Mailing Address - Phone:310-348-0500
Mailing Address - Fax:310-348-0201
Practice Address - Street 1:6700 N 1ST ST
Practice Address - Street 2:STE 131
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-3947
Practice Address - Country:US
Practice Address - Phone:714-633-4666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA81422207KA0200X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA81422AOtherPPIN
CAWA81422AOtherPPIN