Provider Demographics
NPI:1023156957
Name:SEGARRA VALENTIN, ISMAEL ANTONIO
Entity type:Individual
Prefix:DR
First Name:ISMAEL
Middle Name:ANTONIO
Last Name:SEGARRA VALENTIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3286
Mailing Address - Street 2:MARINA STATION
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-3286
Mailing Address - Country:US
Mailing Address - Phone:787-805-0707
Mailing Address - Fax:787-652-4795
Practice Address - Street 1:CALLE MENDEZ VIGO #63
Practice Address - Street 2:EDIFICIO TORRE DE HOSTOS OF. 1D
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-805-0707
Practice Address - Fax:787-652-4795
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2018-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLS260400770180111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor