Provider Demographics
NPI:1427276443
Name:SEGOVIA, JAIME
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:
Last Name:SEGOVIA
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 1:4152 BROADVIEW RD
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-6975
Mailing Address - Country:US
Mailing Address - Phone:505-525-5635
Mailing Address - Fax:505-647-8804
Practice Address - Street 1:1100 S MAIN ST
Practice Address - Street 2:SUITE 20
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-2917
Practice Address - Country:US
Practice Address - Phone:505-525-5635
Practice Address - Fax:505-647-8804
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator