Provider Demographics
NPI:1902587009
Name:SEGOVIA SEGOVIA, YELITZA
Entity Type:Individual
Prefix:
First Name:YELITZA
Middle Name:
Last Name:SEGOVIA SEGOVIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3531 W 110TH TER
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-2181
Mailing Address - Country:US
Mailing Address - Phone:786-312-5121
Mailing Address - Fax:
Practice Address - Street 1:3531 W 110TH TER
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018-2181
Practice Address - Country:US
Practice Address - Phone:786-312-5121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician