Provider Demographics
NPI:1013631977
Name:SEGURA, CAMERON SEGURA THOMAS (RD)
Entity Type:Individual
Prefix:
First Name:CAMERON SEGURA
Middle Name:THOMAS
Last Name:SEGURA
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4901 W 93RD AVE APT 2423
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80031-6337
Mailing Address - Country:US
Mailing Address - Phone:970-590-9978
Mailing Address - Fax:
Practice Address - Street 1:4901 W 93RD AVE APT 2423
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80031-6337
Practice Address - Country:US
Practice Address - Phone:970-590-9978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO86054084133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty