Provider Demographics
NPI:1881233401
Name:SEGURA,, GINA RENEE (ASSOCIATES)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:RENEE
Last Name:SEGURA,
Suffix:
Gender:F
Credentials:ASSOCIATES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 N GREENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-7424
Mailing Address - Country:US
Mailing Address - Phone:575-420-3747
Mailing Address - Fax:
Practice Address - Street 1:110 E MESCALERO RD
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-6542
Practice Address - Country:US
Practice Address - Phone:575-755-2270
Practice Address - Fax:575-627-0405
Is Sole Proprietor?:No
Enumeration Date:2019-12-30
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician