MEDICARE: JOISABEL SEGARRA PEREZ

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	390200000X	Student in an Organized Health Care Education/Training Program	PSI46143	FL

General Provider Information

NPI Number	:	1790613404
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOISABEL SEGARRA PEREZ

Provider Business Mailing Address
First Line	:	4814 W PACIFIC VIEW TER APT 207
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-2381
Country	:	US
Telephone Number	:	787-426-5386
Fax Number	:

Provider Business Practice Location Address
First Line	:	4814 W PACIFIC VIEW TER APT 207
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-2381
Country	:	US
Telephone Number	:	787-426-5386
Fax Number	:

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

Provider Enumeration Date	:	05/12/2026
Last Update Date	:	05/12/2026

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