Healthcare Provider Details

I. General information

NPI: 1780339820
Provider Name (Legal Business Name): KARINA SEGURA LARA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2022
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5560 S UNIVERSITY DR APT 4212
DAVIE FL
33328-5349
US

IV. Provider business mailing address

5560 S UNIVERSITY DR APT 4212
DAVIE FL
33328-5349
US

V. Phone/Fax

Practice location:
  • Phone: 305-397-4187
  • Fax:
Mailing address:
  • Phone: 305-397-4187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH27433
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: