Healthcare Provider Details

I. General information

NPI: 1003875188
Provider Name (Legal Business Name): ZULMA NAHIR LARACUENTE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 09/28/2022
Certification Date: 09/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176 VERSAILLES BLVD
ALEXANDRIA LA
71303-2493
US

IV. Provider business mailing address

176 VERSAILLES BLVD
ALEXANDRIA LA
71303-2493
US

V. Phone/Fax

Practice location:
  • Phone: 318-445-9331
  • Fax: 318-619-6899
Mailing address:
  • Phone: 318-445-9331
  • Fax: 318-619-6899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD.202029
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME84557
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: