Provider Demographics
NPI:1508284936
Name:SURILLO-DAHDAH, LAURA S (MD)
Entity Type:Individual
Prefix:MISS
First Name:LAURA
Middle Name:S
Last Name:SURILLO-DAHDAH
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:PO BOX 190151
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-0151
Mailing Address - Country:US
Mailing Address - Phone:787-751-2509
Mailing Address - Fax:
Practice Address - Street 1:MANATI MEDICAL CENTER PROFESSIONAL PLAZA OFIC. 611
Practice Address - Street 2:CALLE HERNANDEZ CARRION
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-621-3755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-02
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR191342084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology