Provider Demographics
NPI:1154088342
Name:LAUREANO OTERO, ASHLEY ANN
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:ANN
Last Name:LAUREANO OTERO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:V4 CALLE H URB.EL ROSARIO II
Mailing Address - Street 2:
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00693-5739
Mailing Address - Country:US
Mailing Address - Phone:787-212-3899
Mailing Address - Fax:
Practice Address - Street 1:2 CARR. 140
Practice Address - Street 2:BO. MANATI ABAJO
Practice Address - City:BARCELONETA
Practice Address - State:PR
Practice Address - Zip Code:00617
Practice Address - Country:US
Practice Address - Phone:787-846-6829
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-22
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6910183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist