Provider Demographics
NPI:1457556581
Name:SEGIL, CLIFFORD (DO)
Entity Type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:
Last Name:SEGIL
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 1:6029 BRISTOL PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-4899
Mailing Address - Country:US
Mailing Address - Phone:310-417-5900
Mailing Address - Fax:310-410-1001
Practice Address - Street 1:2001 SANTA MONICA BLVD
Practice Address - Street 2:860
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2102
Practice Address - Country:US
Practice Address - Phone:310-828-3209
Practice Address - Fax:310-828-5165
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A93992084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW14560COtherPTAN
CA20A9399Medicaid
CAW14560OtherPTAN
CAW14560OtherPTAN