Provider Demographics
NPI:1700840808
Name:LAUREANO-RODRIGUEZ, ZAIDA M (MD)
Entity Type:Individual
Prefix:DR
First Name:ZAIDA
Middle Name:M
Last Name:LAUREANO-RODRIGUEZ
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 2042
Mailing Address - Street 2:
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00694-2042
Mailing Address - Country:US
Mailing Address - Phone:787-448-9248
Mailing Address - Fax:787-858-4928
Practice Address - Street 1:A-2 CALLE 1
Practice Address - Street 2:URB. VILLA REAL
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693
Practice Address - Country:US
Practice Address - Phone:787-858-4928
Practice Address - Fax:787-858-4928
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14605208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR22890LAOtherTRIPLE-S
PRI48066Medicare UPIN
PR0022890Medicare ID - Type Unspecified