MEDICARE: ROSE SEGOVIA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1356023386
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSE SEGOVIA

Provider Business Mailing Address
First Line	:	2959 NORTHERN BLVD APT 40H
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-3680
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2959 NORTHERN BLVD APT 40H
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-3680
Country	:	US
Telephone Number	:	323-974-5078
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2023
Last Update Date	:	08/01/2023

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Directions to “ ROSE SEGOVIA ” Practice Location

Language	Start Address	Practice Location

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