Healthcare Provider Details

I. General information

NPI: 1366374233
Provider Name (Legal Business Name): ROSA SEGUNDO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4540 CALIFORNIA AVE # 560
BAKERSFIELD CA
93309-7022
US

IV. Provider business mailing address

4560 CALIFORNIA AVE # 560
BAKERSFIELD CA
93309-1374
US

V. Phone/Fax

Practice location:
  • Phone: 661-634-9877
  • Fax:
Mailing address:
  • Phone: 661-634-9877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberRT1442880526
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: