Provider Demographics
NPI:1194690115
Name:SEGOVIA, MARLENE (RDMS(BR))
Entity type:Individual
Prefix:
First Name:MARLENE
Middle Name:
Last Name:SEGOVIA
Suffix:
Gender:F
Credentials:RDMS(BR)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3351 NW 21ST CT
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33066-2223
Mailing Address - Country:US
Mailing Address - Phone:954-232-2621
Mailing Address - Fax:
Practice Address - Street 1:3351 NW 21ST CT
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33066-2223
Practice Address - Country:US
Practice Address - Phone:954-232-2621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-08
Last Update Date:2025-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLL250004092502085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound