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General NPI Number Information
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NPI Number | 1043490113
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Entity Type | Individual
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Provider Name | JENNIFER LAIACONA CAICEDO M.D.
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Gender | Female
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Dates
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Enumeration Date | 11/06/2007
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 8045 PROVIDENCE RD STE 300
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City | CHARLOTTE
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State | NC
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Zip | 28277
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Country | US
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Telephone | 704-341-9600
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Fax | 855-380-3762
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Provider Business Mailing Address
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Address Line | 8045 PROVIDENCE RD STE 300
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City | CHARLOTTE
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State | NC
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Zip | 28277-8915
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Country | US
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Telephone | 704-341-9600
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Fax | 855-380-3762
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 2009-00855
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number | 2009-00855
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License Number State | NC
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