Provider Demographics
NPI:1780061150
Name:VAIL, SELINA S P (MD)
Entity type:Individual
Prefix:
First Name:SELINA
Middle Name:S P
Last Name:VAIL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SELINA
Other - Middle Name:S
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:200 N ROBERTSON BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-6002
Mailing Address - Country:US
Mailing Address - Phone:800-700-6424
Mailing Address - Fax:
Practice Address - Street 1:200 N ROBERTSON BLVD STE 101
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-6002
Practice Address - Country:US
Practice Address - Phone:800-700-6424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-05
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA147437207Q00000X
NY287455207Q00000X
CT56047207Q00000X
MI4301110938207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine