Provider Demographics
NPI:1407192669
Name:SEGURA, ALEXANDRA EMPERATRIZ (LVN)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:EMPERATRIZ
Last Name:SEGURA
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10121 BURNET AVE
Mailing Address - Street 2:
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91345-2715
Mailing Address - Country:US
Mailing Address - Phone:818-263-7991
Mailing Address - Fax:818-885-9575
Practice Address - Street 1:10121 BURNET AVE
Practice Address - Street 2:
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-2715
Practice Address - Country:US
Practice Address - Phone:818-263-7991
Practice Address - Fax:818-885-9575
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-17
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA206000171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator