Provider Demographics
NPI:1407173529
Name:BERTONCINI, LAURA ANA (LAP DOM)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:ANA
Last Name:BERTONCINI
Suffix:
Gender:F
Credentials:LAP DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3626 WARBLER DR
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652-6445
Mailing Address - Country:US
Mailing Address - Phone:352-340-7471
Mailing Address - Fax:
Practice Address - Street 1:15215 US HIGHWAY 19
Practice Address - Street 2:SUITE H
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-3675
Practice Address - Country:US
Practice Address - Phone:727-828-7070
Practice Address - Fax:727-295-7001
Is Sole Proprietor?:No
Enumeration Date:2010-04-29
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2812171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist