Healthcare Provider Details

I. General information

NPI: 1922622182
Provider Name (Legal Business Name): LISA SEGURA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2020
Last Update Date: 12/06/2023
Certification Date: 11/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5284 ADOLFO RD STE 100
CAMARILLO CA
93012-6790
US

IV. Provider business mailing address

3601 CALLE TECATE STE 201
CAMARILLO CA
93012-5056
US

V. Phone/Fax

Practice location:
  • Phone: 805-289-0120
  • Fax:
Mailing address:
  • Phone: 805-289-0120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: