Provider Demographics
NPI:1316926462
Name:SIEGEL, GEORGE (MA)
Entity type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:
Last Name:SIEGEL
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:481 E 19TH ST
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-2313
Mailing Address - Country:US
Mailing Address - Phone:949-650-0456
Mailing Address - Fax:949-650-0921
Practice Address - Street 1:1600 W COAST HWY STE G
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-5000
Practice Address - Country:US
Practice Address - Phone:949-650-0456
Practice Address - Fax:949-650-0921
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-16
Last Update Date:2024-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6791225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist