Provider Demographics
NPI:1790564060
Name:SEGOVIA, DAVID (SRNA)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:SEGOVIA
Suffix:
Gender:M
Credentials:SRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 CALLE 44 SE APT 1
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00921-2718
Mailing Address - Country:US
Mailing Address - Phone:804-938-0799
Mailing Address - Fax:
Practice Address - Street 1:1010 CALLE 44 SE APT 1
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-2718
Practice Address - Country:US
Practice Address - Phone:804-938-0799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC328050163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse