Provider Demographics
NPI:1306920145
Name:SEGAL INDIANER PSYCHIATRIC GROUP
Entity type:Organization
Organization Name:SEGAL INDIANER PSYCHIATRIC GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PERRY
Authorized Official - Middle Name:ROY
Authorized Official - Last Name:SEGAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-395-1441
Mailing Address - Street 1:250 BLOSSOM HILL ROAD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-4420
Mailing Address - Country:US
Mailing Address - Phone:408-395-1441
Mailing Address - Fax:408-395-1441
Practice Address - Street 1:250 BLOSSOM HILL ROAD
Practice Address - Street 2:SUITE 101
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-4420
Practice Address - Country:US
Practice Address - Phone:408-395-1441
Practice Address - Fax:408-395-1441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC392422084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C392420Medicaid
00C392420Medicare ID - Type Unspecified
CA00C392420Medicaid