Provider Demographics
NPI:1457437196
Name:SEALY, JOHN R (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:R
Last Name:SEALY
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 1:23326 HAWTHORNE BLVD
Mailing Address - Street 2:SUITE 375
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-3755
Mailing Address - Country:US
Mailing Address - Phone:310-325-3155
Mailing Address - Fax:310-325-1922
Practice Address - Street 1:23326 HAWTHORNE BLVD
Practice Address - Street 2:SUITE 375
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-3755
Practice Address - Country:US
Practice Address - Phone:310-325-3155
Practice Address - Fax:310-325-1922
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG174572084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
F76498Medicare UPIN
F76498Medicare UPIN