Provider Demographics
NPI:1598986960
Name:SEGARRA, GEIDA LUZ (MD)
Entity Type:Individual
Prefix:DR
First Name:GEIDA
Middle Name:LUZ
Last Name:SEGARRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 79430
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00984-9430
Mailing Address - Country:US
Mailing Address - Phone:787-721-3200
Mailing Address - Fax:787-721-3265
Practice Address - Street 1:253 CALLE SAN JORGE
Practice Address - Street 2:SUITE 3-A
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00912-3307
Practice Address - Country:US
Practice Address - Phone:787-721-3200
Practice Address - Fax:787-721-3262
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11452207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG41602Medicare UPIN
PR84239Medicare ID - Type Unspecified