Provider Demographics
NPI:1871828723
Name:SECREASE, SETH T (IDC)
Entity Type:Individual
Prefix:
First Name:SETH
Middle Name:T
Last Name:SECREASE
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 1ST ST
Mailing Address - Street 2:
Mailing Address - City:PORT HUENEME
Mailing Address - State:CA
Mailing Address - Zip Code:93043-2507
Mailing Address - Country:US
Mailing Address - Phone:858-776-4022
Mailing Address - Fax:
Practice Address - Street 1:NAVAL CLINIC PORT HUENEME
Practice Address - Street 2:162 1ST ST
Practice Address - City:PORT HUENEME
Practice Address - State:CA
Practice Address - Zip Code:93043-0001
Practice Address - Country:US
Practice Address - Phone:619-522-6195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-09
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman