Healthcare Provider Details

I. General information

NPI: 1902255854
Provider Name (Legal Business Name): CARLOS SEGOVIA M.D,
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2016
Last Update Date: 06/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17779 SW 2ND STREET
PEMBROKE PINES FL
33029
US

IV. Provider business mailing address

17779 SW 2ND STREET
PEMBROKE PINES FL
33029
US

V. Phone/Fax

Practice location:
  • Phone: 954-322-1110
  • Fax: 954-322-1099
Mailing address:
  • Phone: 954-322-1110
  • Fax: 954-322-1099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License NumberHSE3054
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: