Provider Demographics
NPI:1386025856
Name:IRASTORZA, LAURA EILEEN (MD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:EILEEN
Last Name:IRASTORZA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 SW 62ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-3009
Mailing Address - Country:US
Mailing Address - Phone:305-662-8357
Mailing Address - Fax:305-669-6406
Practice Address - Street 1:3100 SW 62ND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-3009
Practice Address - Country:US
Practice Address - Phone:305-662-8357
Practice Address - Fax:305-669-6406
Is Sole Proprietor?:No
Enumeration Date:2015-06-10
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1359052080P0206X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology