Healthcare Provider Details

I. General information

NPI: 1649220609
Provider Name (Legal Business Name): ANGEL FERNANDO LAUREANO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 07/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ROAD 152, KM 10.7 CEDRO ARRIBA
NARANJITO PR
00719-3801
US

IV. Provider business mailing address

PO BOX 100
BARRANQUITAS PR
00794-0100
US

V. Phone/Fax

Practice location:
  • Phone: 787-869-8048
  • Fax:
Mailing address:
  • Phone: 787-869-8048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number9057
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: