Provider Demographics
NPI:1659303089
Name:LARACUENTE, EDNA E (MD)
Entity Type:Individual
Prefix:
First Name:EDNA
Middle Name:E
Last Name:LARACUENTE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:HACIENDA SAN JOSE 749 VIA FAROLERO
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727
Mailing Address - Country:US
Mailing Address - Phone:787-258-5782
Mailing Address - Fax:787-258-5782
Practice Address - Street 1:PROFESSIONAL CENTER BUILDING MUNOZ RIVERA 2 SUITE 312
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-746-3234
Practice Address - Fax:787-743-3769
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1410072084P0800X
PR140072084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0023047Medicare ID - Type Unspecified
I27341Medicare UPIN