Provider Demographics
NPI:1184988669
Name:SECRIST, MICHAEL HOLMES (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:HOLMES
Last Name:SECRIST
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3751 KATELLA AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-3113
Mailing Address - Country:US
Mailing Address - Phone:562-598-1311
Mailing Address - Fax:562-598-0355
Practice Address - Street 1:3751 KATELLA AVE
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3113
Practice Address - Country:US
Practice Address - Phone:562-598-1311
Practice Address - Fax:562-598-0355
Is Sole Proprietor?:No
Enumeration Date:2012-06-28
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA1494952085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology