Provider Demographics
NPI:1912395146
Name:SEBERN, CARL DEAN
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:DEAN
Last Name:SEBERN
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 1:1023 CAMINO ALISOS
Mailing Address - Street 2:
Mailing Address - City:FALLBROOK
Mailing Address - State:CA
Mailing Address - Zip Code:92028-3763
Mailing Address - Country:US
Mailing Address - Phone:760-731-2229
Mailing Address - Fax:760-731-2232
Practice Address - Street 1:1023 CAMINO ALISOS
Practice Address - Street 2:
Practice Address - City:FALLBROOK
Practice Address - State:CA
Practice Address - Zip Code:92028-3763
Practice Address - Country:US
Practice Address - Phone:949-300-4432
Practice Address - Fax:760-731-2232
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-22
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT12095225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist