Provider Demographics
NPI:1003245853
Name:SEGURA, ISELA
Entity Type:Individual
Prefix:
First Name:ISELA
Middle Name:
Last Name:SEGURA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 LARISA CIR
Mailing Address - Street 2:
Mailing Address - City:EAGLE PASS
Mailing Address - State:TX
Mailing Address - Zip Code:78852-5515
Mailing Address - Country:US
Mailing Address - Phone:830-352-5258
Mailing Address - Fax:
Practice Address - Street 1:3406 BOB ROGERS DR
Practice Address - Street 2:
Practice Address - City:EAGLE PASS
Practice Address - State:TX
Practice Address - Zip Code:78852-5941
Practice Address - Country:US
Practice Address - Phone:830-757-4900
Practice Address - Fax:830-757-4958
Is Sole Proprietor?:No
Enumeration Date:2013-11-02
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA08689363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical