Provider Demographics
NPI:1851521553
Name:SEBASTIAN, JOSE LUIS
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:LUIS
Last Name:SEBASTIAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6475 ATLANTIC AVE
Mailing Address - Street 2:SPACE 527
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90805-7366
Mailing Address - Country:US
Mailing Address - Phone:562-366-1036
Mailing Address - Fax:
Practice Address - Street 1:6475 ATLANTIC AVE
Practice Address - Street 2:SPC 527
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90805-7366
Practice Address - Country:US
Practice Address - Phone:562-366-1036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-16
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Y00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Health Information