Healthcare Provider Details

I. General information

NPI: 1497229355
Provider Name (Legal Business Name): ISRAEL LARACUENTE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2019
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3111 CALLE ATALAYA ALTURAS DE MAYAGUEZ
MAYAGUEZ PR
00682
US

IV. Provider business mailing address

PO BOX 260087
SAN JUAN PR
00926-2617
US

V. Phone/Fax

Practice location:
  • Phone: 787-617-5931
  • Fax:
Mailing address:
  • Phone: 787-617-5931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME174078
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number23926
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: