MEDICARE: DR. LAURA C PLAZA CARRILLO 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	208100000X	Physical Medicine & Rehabilitation Physician	11050	PR

General Provider Information

NPI Number	:	1598827297
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAURA C PLAZA CARRILLO M.D.

Provider Business Mailing Address
First Line	:	PO BOX 33068
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00933-3068
Country	:	US
Telephone Number	:	787-620-9797
Fax Number	:

Provider Business Practice Location Address
First Line	:	1733 CALLE THEIS
Second Line	:	RIO PIEDRAS HEIGHTS
City	:	SAN JUAN
State	:	PR
Zip	:	00926-3248
Country	:	US
Telephone Number	:	787-620-9797
Fax Number	:

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

Provider Enumeration Date	:	12/16/2006
Last Update Date	:	04/07/2011

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