Provider Demographics
NPI:1619417607
Name:SEGURA WELLNESS, LLC
Entity Type:Organization
Organization Name:SEGURA WELLNESS, LLC
Other - Org Name:SEGURA NEUROSCIENCE & PAIN CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:C
Authorized Official - Last Name:SEGURA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-231-6751
Mailing Address - Street 1:141 LAKEVIEW CIRCLE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433
Mailing Address - Country:US
Mailing Address - Phone:985-231-6751
Mailing Address - Fax:985-888-1838
Practice Address - Street 1:141 LAKEVIEW CIRCLE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433
Practice Address - Country:US
Practice Address - Phone:985-231-6751
Practice Address - Fax:985-888-1838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-24
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.200721208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1467619254OtherPERSONAL NPI
LA4N157Medicare UPIN