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General NPI Number Information
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NPI Number | 1659303089
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Entity Type | Individual
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Provider Name | EDNA E LARACUENTE M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/07/2006
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Last Update Date | 02/26/2014
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Provider Practice Location Address
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Address Line | PROFESSIONAL CENTER BUILDING MUNOZ RIVERA 2 SUITE 312
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City | CAGUAS
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State | PR
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Zip | 00725
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Country | US
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Telephone | 787-746-3234
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Fax | 787-743-3769
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Provider Business Mailing Address
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Address Line | HACIENDA SAN JOSE 749 VIA FAROLERO
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City | CAGUAS
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State | PR
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Zip | 00727
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Country | US
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Telephone | 787-258-5782
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Fax | 787-258-5782
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 141007
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 14007
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License Number State | PR
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