Healthcare Provider Details

I. General information

NPI: 1114010980
Provider Name (Legal Business Name): YAMILLE SEGUI LPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 08/22/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 CALLE YABOA COSTA BRAVA
ISABELA PR
00662-6326
US

IV. Provider business mailing address

PMB 266 PO BOX 10000
CANOVANAS PR
00729
US

V. Phone/Fax

Practice location:
  • Phone: 787-647-6477
  • Fax: 787-876-6823
Mailing address:
  • Phone: 787-647-6477
  • Fax: 787-876-6823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number001214
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: