Healthcare Provider Details

I. General information

NPI: 1629319298
Provider Name (Legal Business Name): DANIEL DE JESUS SEGUI HOUSE PHYSICIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2013
Last Update Date: 11/15/2025
Certification Date: 11/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

543 W 45TH PL
HIALEAH FL
33012-3862
US

IV. Provider business mailing address

543 W 45TH PL
HIALEAH FL
33012-3862
US

V. Phone/Fax

Practice location:
  • Phone: 305-582-5776
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number002964
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: