Provider Demographics
NPI:1356644173
Name:SEGOVIA, ANGELA LYNN (PA-C)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:LYNN
Last Name:SEGOVIA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1070 S SANTA FE AVE STE 10
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92084-7010
Mailing Address - Country:US
Mailing Address - Phone:760-941-7022
Mailing Address - Fax:760-941-7142
Practice Address - Street 1:1070 S SANTA FE AVE STE 10
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92084-7010
Practice Address - Country:US
Practice Address - Phone:760-941-7022
Practice Address - Fax:760-941-7142
Is Sole Proprietor?:No
Enumeration Date:2010-12-16
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA21235363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical