Provider Demographics
NPI:1487015103
Name:CLARA LAGUERUELA MD, P.A.
Entity Type:Organization
Organization Name:CLARA LAGUERUELA MD, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CLARA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAGUERUELA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-223-2255
Mailing Address - Street 1:9980 SW 40TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-3944
Mailing Address - Country:US
Mailing Address - Phone:305-223-2255
Mailing Address - Fax:305-223-2622
Practice Address - Street 1:9980 SW 40TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-3944
Practice Address - Country:US
Practice Address - Phone:305-223-2255
Practice Address - Fax:305-223-2622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-08
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0059638208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRVOWWOtherBCBS GROUP NUMBER