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General NPI Number Information
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NPI Number | 1104120682
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Entity Type | Organization
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Legal Business Name | LAURA DE LA NUEZ, PSY.D., P.A.
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Dates
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Enumeration Date | 12/27/2010
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Last Update Date | 12/27/2010
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Provider Practice Location Address
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Address Line | 2100 PONCE DE LEON BLVD SUITE 1015
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City | CORAL GABLES
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State | FL
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Zip | 33134-5215
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Country | US
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Telephone | 786-797-7788
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Fax |
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Provider Business Mailing Address
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Address Line | 6736 MAGNOLIA CT
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City | MIAMI
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State | FL
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Zip | 33143-3275
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Country | US
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Telephone | 786-797-7788
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. LAURA DE LA NUEZ
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Credential | PSY.D
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Telephone | 786-797-7788
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PY7223
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License Number State | FL
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