Provider Demographics
NPI:1407398639
Name:JUAREZ, LAURA ELISE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:ELISE
Last Name:JUAREZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 615
Mailing Address - Street 2:
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-0615
Mailing Address - Country:US
Mailing Address - Phone:801-362-6791
Mailing Address - Fax:
Practice Address - Street 1:DR JOSE CELSO BARBOSA DRIVE
Practice Address - Street 2:RECINTO CIENCIAS MEDICAS, UPR
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921
Practice Address - Country:US
Practice Address - Phone:801-362-6791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-04
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56826363AS0400X
PR000919208600000X
UT363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical