Healthcare Provider Details

I. General information

NPI: 1649461195
Provider Name (Legal Business Name): ROSSANA SEGOVIA-BAIN RN, NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2007
Last Update Date: 08/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 DIVISADERO ST # 1661
SAN FRANCISCO CA
94115-3010
US

IV. Provider business mailing address

2915 SANTOS LN APT 2222
WALNUT CREEK CA
94597-7586
US

V. Phone/Fax

Practice location:
  • Phone: 415-885-7665
  • Fax: 415-771-4472
Mailing address:
  • Phone: 925-952-4580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0106X
TaxonomyOccupational Health Nurse Practitioner
License NumberNP 13598
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: