Provider Demographics
NPI:1356663306
Name:SEGURA, RENATO (MD, LAC)
Entity Type:Individual
Prefix:DR
First Name:RENATO
Middle Name:
Last Name:SEGURA
Suffix:
Gender:M
Credentials:MD, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3990 SHERIDAN ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-3661
Mailing Address - Country:US
Mailing Address - Phone:954-987-4455
Mailing Address - Fax:954-964-7342
Practice Address - Street 1:3990 SHERIDAN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3661
Practice Address - Country:US
Practice Address - Phone:954-987-4455
Practice Address - Fax:954-964-7342
Is Sole Proprietor?:No
Enumeration Date:2010-02-18
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2554171100000X
PR018321208D00000X
PR12848-I390200000X
FLME135224208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No171100000XOther Service ProvidersAcupuncturist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FS584AOtherMEDICARE PTAN