Provider Demographics
NPI:1689654733
Name:SEGURITAN, VENERANDO (MD)
Entity Type:Individual
Prefix:DR
First Name:VENERANDO
Middle Name:
Last Name:SEGURITAN
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:PO BOX 16961
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97292-0961
Mailing Address - Country:US
Mailing Address - Phone:808-454-5200
Mailing Address - Fax:808-454-5201
Practice Address - Street 1:640 ULUKAHIKI ST
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734
Practice Address - Country:US
Practice Address - Phone:808-263-5166
Practice Address - Fax:808-263-5167
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI88922085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology