MEDICARE: DR. KRISTON A SEGURA PSY D

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	103T00000X	Psychologist	PY0416	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407819071
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRISTON A SEGURA PSY D

Provider Business Mailing Address
First Line	:	2110 E FLAMINGO RD STE 321
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-5190
Country	:	US
Telephone Number	:	702-308-5114
Fax Number	:	702-829-5403

Provider Business Practice Location Address
First Line	:	2110 E FLAMINGO RD STE 321
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-5190
Country	:	US
Telephone Number	:	702-308-5114
Fax Number	:	702-410-8401

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

Provider Enumeration Date	:	04/06/2006
Last Update Date	:	11/26/2018

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