Healthcare Provider Details

I. General information

NPI: 1669392775
Provider Name (Legal Business Name): ROBERTO LAURELES PA-S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2026
Last Update Date: 07/18/2026
Certification Date: 07/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 HUNTINGTON AVE
BOSTON MA
02115-5000
US

IV. Provider business mailing address

168 ALBION ST APT 1
SOMERVILLE MA
02144-2646
US

V. Phone/Fax

Practice location:
  • Phone: 617-373-2000
  • Fax:
Mailing address:
  • Phone: 781-799-1602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: