Healthcare Provider Details

I. General information

NPI: 1144979949
Provider Name (Legal Business Name): MD HEALTHCARE BOCA RATON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2022
Last Update Date: 12/06/2022
Certification Date: 12/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7050 W. PALMETTO PARK ROAD SUITE 30
BOCA RATON FL
33433
US

IV. Provider business mailing address

304 INDIAN TRACE SUITE 636
WESTON FL
33326
US

V. Phone/Fax

Practice location:
  • Phone: 954-425-9154
  • Fax: 866-981-1882
Mailing address:
  • Phone: 786-553-9745
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RENATO SEGURA
Title or Position: MEDICAL DIRECTOR/PRESIDENT
Credential: M.D.
Phone: 786-301-4164