Provider Demographics
NPI:1194958736
Name:SEDA, AXEL
Entity type:Individual
Prefix:
First Name:AXEL
Middle Name:
Last Name:SEDA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 CALLE ORQUIDEA
Mailing Address - Street 2:ESTANCIAS DE LA FUENTE
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953-3610
Mailing Address - Country:US
Mailing Address - Phone:787-949-4343
Mailing Address - Fax:
Practice Address - Street 1:62 CALLE ORQUIDEA
Practice Address - Street 2:ESTANCIAS DE LA FUENTE
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953-3610
Practice Address - Country:US
Practice Address - Phone:787-949-4343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-31
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1783451172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver