MEDICARE: JOANCY MARIE ARCHEVAL LAO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	17378-I	PR

General Provider Information

NPI Number	:	1093666877
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOANCY MARIE ARCHEVAL LAO

Provider Business Mailing Address
First Line	:	3614 CALLE SANTA JUANITA
Second Line	:
City	:	PONCE
State	:	PR
Zip	:	00730-4626
Country	:	US
Telephone Number	:	713-471-0793
Fax Number	:

Provider Business Practice Location Address
First Line	:	900 PR-696
Second Line	:
City	:	DORADO
State	:	PR
Zip	:	00646
Country	:	US
Telephone Number	:	713-471-0793
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2026
Last Update Date	:	02/06/2026

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