Healthcare Provider Details

I. General information

NPI: 1477886737
Provider Name (Legal Business Name): MILA SEGUERRA-DOCTURA MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2009
Last Update Date: 09/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 SHAMROCK BLVD
VENICE FL
34293-1630
US

IV. Provider business mailing address

119 SHAMROCK BLVD
VENICE FL
34293-1630
US

V. Phone/Fax

Practice location:
  • Phone: 941-493-3282
  • Fax: 941-493-1672
Mailing address:
  • Phone: 941-493-3282
  • Fax: 941-493-1672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME0032680
License Number StateFL

VIII. Authorized Official

Name: DR. MILA SEGUERRA-DOCTORA MD PA
Title or Position: PHYSICIAN/OWNER
Credential: MD
Phone: 941-493-3282