Healthcare Provider Details

I. General information

NPI: 1982613337
Provider Name (Legal Business Name): MILAGROS M SEGUERRA-DOCTORA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 02/21/2020
Certification Date: 02/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 SHAMROCK BLVD
VENICE FL
34293
US

IV. Provider business mailing address

700 8TH AVE W STE 101
PALMETTO FL
34221-4737
US

V. Phone/Fax

Practice location:
  • Phone: 941-493-3282
  • Fax: 941-493-1672
Mailing address:
  • Phone: 941-776-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME32680
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: