1336369610 NPI number — DR. LUCERY MEDINA-LAUREANO PHD

Table of content: DR. LUCERY MEDINA-LAUREANO PHD (NPI 1336369610)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336369610 NPI number — DR. LUCERY MEDINA-LAUREANO PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MEDINA-LAUREANO
Provider First Name:
LUCERY
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336369610
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
ROAD 155 CORNER ROAD. 643 KM 58.3
Provider Second Line Business Mailing Address:
BO. PUGNADO
Provider Business Mailing Address City Name:
VEGA BAJA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00693-3549
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-448-9374
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
411 CALLE LISA
Provider Second Line Business Practice Location Address:
SAN DEMETRIO
Provider Business Practice Location Address City Name:
VEGA BAJA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00693-3549
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-448-9374
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC2200X , with the licence number:  1862 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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