MEDICARE: ALEXANDRA DE LEON SEGARRA PHYSICIAN ASSISTANT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	002267-P.A.	PR

General Provider Information

NPI Number	:	1245193739
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDRA DE LEON SEGARRA PHYSICIAN ASSISTANT

Provider Business Mailing Address
First Line	:	1700 CALLE SANTA AGUEDA
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00926-4312
Country	:	US
Telephone Number	:	787-565-6869
Fax Number	:

Provider Business Practice Location Address
First Line	:	1700 CALLE SANTA AGUEDA
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00926-4312
Country	:	US
Telephone Number	:	787-565-6869
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/03/2025
Last Update Date	:	12/03/2025

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