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General NPI Number Information
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NPI Number | 1427939842
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Entity Type | Individual
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Provider Name | MADISON LEEANN SEGARRA
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Gender | Female
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Dates
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Enumeration Date | 09/11/2025
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 109 N AVENUE 56 STE B
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City | LOS ANGELES
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State | CA
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Zip | 90042-4111
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Country | US
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Telephone | 213-793-8223
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Fax |
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Provider Business Mailing Address
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Address Line | 770 S GRAND AVE APT 6039
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City | LOS ANGELES
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State | CA
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Zip | 90017-3955
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Country | US
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Telephone | 813-405-7140
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | CA
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