Provider Demographics
NPI:1154388650
Name:SEMINO, HOUSHANG (MD)
Entity type:Individual
Prefix:DR
First Name:HOUSHANG
Middle Name:
Last Name:SEMINO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11638 N 12TH PL
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-1221
Mailing Address - Country:US
Mailing Address - Phone:602-390-2496
Mailing Address - Fax:602-293-3236
Practice Address - Street 1:17215 N 72ND DR
Practice Address - Street 2:D-140A
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-8558
Practice Address - Country:US
Practice Address - Phone:623-487-9630
Practice Address - Fax:623-487-9631
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ107512084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZD00293Medicare UPIN
AZ21485Medicare ID - Type Unspecified