Healthcare Provider Details

I. General information

NPI: 1497902795
Provider Name (Legal Business Name): ERANDY YURITZIA SEGURA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2008
Last Update Date: 08/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1745 W ORANGEWOOD AVE STE 103
ORANGE CA
92868-2041
US

IV. Provider business mailing address

1818 W CARLTON PL
SANTA ANA CA
92704-4205
US

V. Phone/Fax

Practice location:
  • Phone: 714-221-6400
  • Fax: 714-221-6401
Mailing address:
  • Phone: 714-979-9782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: