Provider Demographics
NPI:1316540685
Name:SEGUI AVILES, MARIANGELY
Entity Type:Individual
Prefix:
First Name:MARIANGELY
Middle Name:
Last Name:SEGUI AVILES
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:HC 56 BOX 4670
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602-8640
Mailing Address - Country:US
Mailing Address - Phone:787-942-8078
Mailing Address - Fax:
Practice Address - Street 1:CALLE COLON #4 CARR. 115 KM. 24.5
Practice Address - Street 2:EDIF. AGUADA COMPLEX 2DO PISO SUITE 5
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602
Practice Address - Country:US
Practice Address - Phone:787-609-6555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-19
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR148891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR6008828Medicaid