Healthcare Provider Details

I. General information

NPI: 1508780685
Provider Name (Legal Business Name): NICOLE SEGROVES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2832 PAXTON AVE
PALMDALE CA
93551-1015
US

IV. Provider business mailing address

2832 PAXTON AVE
PALMDALE CA
93551-1015
US

V. Phone/Fax

Practice location:
  • Phone: 661-874-7885
  • Fax: 661-524-9950
Mailing address:
  • Phone:
  • Fax: 661-524-9950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: