Provider Demographics
NPI:1821461203
Name:SETON MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:SETON MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HERMINIGILDO
Authorized Official - Middle Name:VILLON
Authorized Official - Last Name:VALLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-991-7003
Mailing Address - Street 1:1850 SULLIVAN AVE
Mailing Address - Street 2:SUITE 510
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-2221
Mailing Address - Country:US
Mailing Address - Phone:650-991-7003
Mailing Address - Fax:650-991-3119
Practice Address - Street 1:1850 SULLIVAN AVE
Practice Address - Street 2:SUITE 510
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-2221
Practice Address - Country:US
Practice Address - Phone:650-991-7003
Practice Address - Fax:650-991-3119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-05
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty