Provider Demographics
NPI:1821110891
Name:SVETLANA G. SEGAL M.D.,PH.D.,CORPORATION
Entity Type:Organization
Organization Name:SVETLANA G. SEGAL M.D.,PH.D.,CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER,PROVIDER,PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SVETLANA
Authorized Official - Middle Name:
Authorized Official - Last Name:SEGAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD,PHD
Authorized Official - Phone:323-651-3228
Mailing Address - Street 1:6221 WILSHIRE BLVD
Mailing Address - Street 2:#210
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5201
Mailing Address - Country:US
Mailing Address - Phone:323-651-3228
Mailing Address - Fax:323-651-0280
Practice Address - Street 1:6221 WILSHIRE BLVD
Practice Address - Street 2:#210
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5201
Practice Address - Country:US
Practice Address - Phone:323-651-3228
Practice Address - Fax:323-651-0280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA38892207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0057100Medicaid
CAGR0057100Medicaid
A85203Medicare UPIN