Provider Demographics
NPI:1659673358
Name:SEGURA VALENZUELA, AURELINA
Entity type:Individual
Prefix:
First Name:AURELINA
Middle Name:
Last Name:SEGURA VALENZUELA
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:JARDINES DE MONTE ALTO # 325
Mailing Address - Street 2:APT. 41
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976-4943
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1306 AVE FERNANDEZ JUNCOS
Practice Address - Street 2:PDA 19 SANTURCE
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-2521
Practice Address - Country:US
Practice Address - Phone:787-480-3028
Practice Address - Fax:787-725-8260
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-01
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR189101YA0400X
PR1340101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional