Provider Demographics
NPI:1831255025
Name:SEAL, ENID L
Entity type:Individual
Prefix:
First Name:ENID
Middle Name:L
Last Name:SEAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27601 FORBES RD
Mailing Address - Street 2:SUITE 24
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-1201
Mailing Address - Country:US
Mailing Address - Phone:949-582-9210
Mailing Address - Fax:949-582-9280
Practice Address - Street 1:27601 FORBES RD
Practice Address - Street 2:SUITE 24
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-1201
Practice Address - Country:US
Practice Address - Phone:949-582-9210
Practice Address - Fax:949-582-9280
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASR EAA99941141174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3901080001Medicare ID - Type Unspecified