Provider Demographics
NPI:1477886737
Name:MILA SEGUERRA-DOCTURA MD PA
Entity Type:Organization
Organization Name:MILA SEGUERRA-DOCTURA MD PA
Other - Org Name:MILAGROS M. SEGUERRA -DOCTORA MD
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MILA
Authorized Official - Middle Name:
Authorized Official - Last Name:SEGUERRA-DOCTORA MD PA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-493-3282
Mailing Address - Street 1:119 SHAMROCK BLVD
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34293-1630
Mailing Address - Country:US
Mailing Address - Phone:941-493-3282
Mailing Address - Fax:941-493-1672
Practice Address - Street 1:119 SHAMROCK BLVD
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34293-1630
Practice Address - Country:US
Practice Address - Phone:941-493-3282
Practice Address - Fax:941-493-1672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-17
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0032680208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL214206OtherAMERIGROUP
FL28840OtherWELLCARE
FL58312OtherBXBS
FL464714OtherAETNA
FL0386901-00Medicaid
FL0386901-00Medicaid