MEDICARE: CLARA LAGUERUELA M.D

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	208000000X	Pediatrics Physician	ME 59638	FL

General Provider Information

NPI Number	:	1568555852
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLARA LAGUERUELA M.D

Provider Business Mailing Address
First Line	:	9980 SW 40TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33165-3944
Country	:	US
Telephone Number	:	305-223-2255
Fax Number	:	305-223-2622

Provider Business Practice Location Address
First Line	:	9980 SW 40TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33165-3944
Country	:	US
Telephone Number	:	305-223-2255
Fax Number	:	305-223-2622

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

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	07/08/2007

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