Provider Demographics
NPI:1598827297
Name:PLAZA CARRILLO, LAURA C (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:C
Last Name:PLAZA CARRILLO
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 33068
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00933-3068
Mailing Address - Country:US
Mailing Address - Phone:787-620-9797
Mailing Address - Fax:
Practice Address - Street 1:1733 CALLE THEIS
Practice Address - Street 2:RIO PIEDRAS HEIGHTS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-3248
Practice Address - Country:US
Practice Address - Phone:787-620-9797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-16
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11050208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR83398Medicare ID - Type Unspecified