Provider Demographics
NPI:1982613337
Name:SEGUERRA-DOCTORA, MILAGROS M (MD)
Entity Type:Individual
Prefix:MRS
First Name:MILAGROS
Middle Name:M
Last Name:SEGUERRA-DOCTORA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 8TH AVE W STE 101
Mailing Address - Street 2:
Mailing Address - City:PALMETTO
Mailing Address - State:FL
Mailing Address - Zip Code:34221-4737
Mailing Address - Country:US
Mailing Address - Phone:941-776-4000
Mailing Address - Fax:
Practice Address - Street 1:119 SHAMROCK BLVD
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34293
Practice Address - Country:US
Practice Address - Phone:941-493-3282
Practice Address - Fax:941-493-1672
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME32680208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL464714OtherAETNA
FL214206OtherAMERIGROUP
FL58312OtherBCBS
FL038690100Medicaid
FL28840OtherWELLCARE
FL58312OtherBCBS