Provider Demographics
NPI:1215991997
Name:SEGOVIA, JOCELYN LEONOR (PAC)
Entity type:Individual
Prefix:MRS
First Name:JOCELYN
Middle Name:LEONOR
Last Name:SEGOVIA
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3157 N RAINBOW BLVD # 518
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89108-4578
Mailing Address - Country:US
Mailing Address - Phone:702-386-4700
Mailing Address - Fax:702-386-4701
Practice Address - Street 1:7220 S CIMARRON RD STE 270
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-2160
Practice Address - Country:US
Practice Address - Phone:702-912-4100
Practice Address - Fax:702-386-4701
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA825363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100503059Medicaid
NV100503059Medicaid