Provider Demographics
NPI:1932648599
Name:CONNOLLY, SEAMUS LUCIEN (DO)
Entity Type:Individual
Prefix:
First Name:SEAMUS
Middle Name:LUCIEN
Last Name:CONNOLLY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81880 DR CARREON BLVD STE B207
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-5585
Mailing Address - Country:US
Mailing Address - Phone:442-324-0014
Mailing Address - Fax:442-324-0016
Practice Address - Street 1:81880 DR CARREON BLVD STE B207
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-5585
Practice Address - Country:US
Practice Address - Phone:442-324-0014
Practice Address - Fax:442-324-0016
Is Sole Proprietor?:No
Enumeration Date:2017-02-15
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A168362084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A16836OtherCALIFORNIA OSTEOPATHIC MEDICAL ASSOCIATION