MEDICARE: PABLO E SEGARRA BOSQUE M.D.

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	208D00000X	General Practice Physician	4942	PR

General Provider Information

NPI Number	:	1972571305
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PABLO E SEGARRA BOSQUE M.D.

Provider Business Mailing Address
First Line	:	PO BOX 370696
Second Line	:
City	:	CAYEY
State	:	PR
Zip	:	00737-0696
Country	:	US
Telephone Number	:	787-738-2021
Fax Number	:	787-738-2021

Provider Business Practice Location Address
First Line	:	CALLE LUIS MUNOZ RIVERA 110 SUR
Second Line	:
City	:	CAYEY
State	:	PR
Zip	:	00736-0000
Country	:	US
Telephone Number	:	787-738-2021
Fax Number	:	787-738-2021

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

Provider Enumeration Date	:	03/10/2006
Last Update Date	:	07/28/2014

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