Provider Demographics
NPI:1558149708
Name:LARACUENTE BORRERO, LAISHA
Entity Type:Individual
Prefix:
First Name:LAISHA
Middle Name:
Last Name:LARACUENTE BORRERO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 LAKEVIEW DR APT 202
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-2471
Mailing Address - Country:US
Mailing Address - Phone:954-296-8898
Mailing Address - Fax:
Practice Address - Street 1:440 LAKEVIEW DR APT 202
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-2471
Practice Address - Country:US
Practice Address - Phone:954-296-8898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-19
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician