Provider Demographics
NPI:1689108847
Name:SEGURA, ELIANA
Entity Type:Individual
Prefix:
First Name:ELIANA
Middle Name:
Last Name:SEGURA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 ROSWELL AVE
Mailing Address - Street 2:APT 9
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-5500
Mailing Address - Country:US
Mailing Address - Phone:707-363-9620
Mailing Address - Fax:
Practice Address - Street 1:12440 FIRESTONE AVE BLVD.
Practice Address - Street 2:3020
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650
Practice Address - Country:US
Practice Address - Phone:562-864-7821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-14
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA390200000XOther390200000X