Healthcare Provider Details

I. General information

NPI: 1467992545
Provider Name (Legal Business Name): MARIA JOSE LAGUNA APRN, DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIA JOSE CABELLO

II. Dates (important events)

Enumeration Date: 03/08/2017
Last Update Date: 11/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15507 NW 67TH AVE
MIAMI LAKES FL
33014-2174
US

IV. Provider business mailing address

900 S PINE ISLAND RD SUITE 800
PLANTATION FL
33324-3920
US

V. Phone/Fax

Practice location:
  • Phone: 305-821-8611
  • Fax:
Mailing address:
  • Phone: 305-821-8611
  • Fax: 305-827-1753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPRN9338544
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: