Provider Demographics
NPI:1942212527
Name:SEHGAL, BANITA B (DO)
Entity Type:Individual
Prefix:
First Name:BANITA
Middle Name:B
Last Name:SEHGAL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 FIR STREET
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-2703
Mailing Address - Country:US
Mailing Address - Phone:858-499-2703
Mailing Address - Fax:619-446-1569
Practice Address - Street 1:300 FIR STREET
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-2703
Practice Address - Country:US
Practice Address - Phone:858-499-2703
Practice Address - Fax:619-446-1569
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2017-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7649207P00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0AX764900Medicaid
CA0AX764900Medicaid
CAW20A7649CMedicare ID - Type Unspecified