Provider Demographics
NPI:1760410195
Name:SESLAR, JON-PAUL (DPM)
Entity Type:Individual
Prefix:
First Name:JON-PAUL
Middle Name:
Last Name:SESLAR
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2089 VALE RD
Mailing Address - Street 2:SUITE 12
Mailing Address - City:SAN PABLO
Mailing Address - State:CA
Mailing Address - Zip Code:94806-3847
Mailing Address - Country:US
Mailing Address - Phone:510-232-0892
Mailing Address - Fax:510-234-5951
Practice Address - Street 1:2089 VALE RD
Practice Address - Street 2:SUITE 12
Practice Address - City:SAN PABLO
Practice Address - State:CA
Practice Address - Zip Code:94806-3847
Practice Address - Country:US
Practice Address - Phone:510-232-0892
Practice Address - Fax:510-234-5951
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4074213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E40740Medicaid
CA000E40740Medicaid
CA000E40740Medicaid