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NPI Code Detail

MEDICARE: LAURA LORENA VIRGEN D.O.

MEDICARE: LAURA LORENA VIRGEN D.O.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician34.014397OH
2390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1063945608
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAURA LORENA VIRGEN D.O.
Provider Business Mailing Address
First Line : 11100 EUCLID AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44106-1716
Country : US
Telephone Number : 216-844-7031
Fax Number :
Provider Business Practice Location Address
First Line : 11100 EUCLID AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44106-1716
Country : US
Telephone Number : 216-844-7031
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/11/2017
Last Update Date : 01/23/2026

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