Provider Demographics
NPI:1285762468
Name:SEGURA, ALICIA
Entity type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:
Last Name:SEGURA
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 1:3717 KIMBO RD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76111-6208
Mailing Address - Country:US
Mailing Address - Phone:817-838-9829
Mailing Address - Fax:817-383-9829
Practice Address - Street 1:3717 KIMBO RD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76111-6208
Practice Address - Country:US
Practice Address - Phone:817-838-9829
Practice Address - Fax:817-383-9829
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000999997OtherTX DEPT OF AGING & DISABI
TX001015605OtherTX DEPARTMENT OF AGING AND DISABILITY