=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316018880
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAURA ALEJANDRA DEL FIERRO D.M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/13/2006
-----------------------------------------------------
Last Update Date | 02/27/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | VILLAS DE RIO GRANDE SHOOPING CENTER #99 PIMENTEL STREET FIRST FLOOR
-----------------------------------------------------
City | RIO GRANDE
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00749
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-887-3595
-----------------------------------------------------
Fax | 787-887-3125
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | CERRILLO STREET AA3 5302 RIVER VALLEY TOWN PARK
-----------------------------------------------------
City | CANOVANAS
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00729
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-312-4363
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 2748
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------