Healthcare Provider Details

I. General information

NPI: 1265406128
Provider Name (Legal Business Name): ENRIQUE SEGURA NIEVES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 03/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PASEO SAN PABLO EDIF DR. ARTURO CADILLA SUITE 408
BAYAMON PR
00961-7019
US

IV. Provider business mailing address

PO BOX 6688 SANTA ROSA UNIT
BAYAMON PR
00960-5688
US

V. Phone/Fax

Practice location:
  • Phone: 787-740-8116
  • Fax: 787-785-7421
Mailing address:
  • Phone: 787-740-8116
  • Fax: 787-785-7421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number5652
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: