=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730218165
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RITA LARACUENTE MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/02/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14325 BENDING BRANCH CT
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32824-6346
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-855-9905
-----------------------------------------------------
Fax | 407-857-2486
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14325 BENDING BRANCH CT
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32824-6346
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-855-9905
-----------------------------------------------------
Fax | 407-857-2486
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | RITA LARACUENTE
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 407-492-7927
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------