MEDICARE: MRS. SONIA LARACUENTE

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	246Z00000X	Other Specialist/Technologist	1602	PR

General Provider Information

NPI Number	:	1245238302
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SONIA LARACUENTE

Provider Business Mailing Address
First Line	:	291 CALLE MENDEZ VIGO
Second Line	:
City	:	DORADO
State	:	PR
Zip	:	00646-4913
Country	:	US
Telephone Number	:	787-796-1003
Fax Number	:	787-796-1003

Provider Business Practice Location Address
First Line	:	291 CALLE MENDEZ VIGO
Second Line	:
City	:	DORADO
State	:	PR
Zip	:	00646-4913
Country	:	US
Telephone Number	:	787-796-1003
Fax Number	:	787-796-1003

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

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	07/08/2007

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