Provider Demographics
NPI:1831605641
Name:MILLAN, SEGISMUNDO SENENSE IV (NP - ADULT GERIATRIC)
Entity type:Individual
Prefix:
First Name:SEGISMUNDO
Middle Name:SENENSE
Last Name:MILLAN
Suffix:IV
Gender:M
Credentials:NP - ADULT GERIATRIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14430 LONGWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-4721
Mailing Address - Country:US
Mailing Address - Phone:562-413-3918
Mailing Address - Fax:
Practice Address - Street 1:2041 W ORANGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-1944
Practice Address - Country:US
Practice Address - Phone:714-560-8177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-17
Last Update Date:2017-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95007471363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology