Provider Demographics
NPI:1598479032
Name:SAN MIGUEL, LAURA DENISSE
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:DENISSE
Last Name:SAN MIGUEL
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 1:720 MINNESOTA 3 N
Mailing Address - Street 2:APT 25
Mailing Address - City:NORTHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55057
Mailing Address - Country:US
Mailing Address - Phone:956-640-8682
Mailing Address - Fax:
Practice Address - Street 1:720 HIGHWAY 3 N APT 25
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55057-9435
Practice Address - Country:US
Practice Address - Phone:956-640-8682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-10
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker