Healthcare Provider Details

I. General information

NPI: 1366869877
Provider Name (Legal Business Name): MR. PEDRO JORGE LAUREANO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2014
Last Update Date: 03/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BU-1 BAIROA AVE LAS AMERICAS
CAGUAS PR
00725
US

IV. Provider business mailing address

PO BOX 4960 PMB 261
CAGUAS PR
00726-4960
US

V. Phone/Fax

Practice location:
  • Phone: 787-743-6434
  • Fax:
Mailing address:
  • Phone: 787-640-8809
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number8528
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: