Healthcare Provider Details

I. General information

NPI: 1871810036
Provider Name (Legal Business Name): LUZ MARIA SEGOVIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2010
Last Update Date: 02/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 HUGHES WAY STE 150
LONG BEACH CA
90810-1878
US

IV. Provider business mailing address

4016 S HOBART BLVD
LOS ANGELES CA
90062-1618
US

V. Phone/Fax

Practice location:
  • Phone: 310-221-6336
  • Fax:
Mailing address:
  • Phone: 323-208-2295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number97205
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: