Healthcare Provider Details

I. General information

NPI: 1841812914
Provider Name (Legal Business Name): LAURA MARCELA VERGARA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2020
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3250 MERIDIAN PKWY FL 33331
WESTON FL
33331-3502
US

IV. Provider business mailing address

3250 MERIDIAN PKWY FL 33331
WESTON FL
33331-3502
US

V. Phone/Fax

Practice location:
  • Phone: 954-659-5867
  • Fax: 954-659-5354
Mailing address:
  • Phone: 954-659-5867
  • Fax: 954-659-5354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME173598
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036165205
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: