Provider Demographics
NPI:1013656693
Name:CARTAGENA, LAURA LUCELY
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:LUCELY
Last Name:CARTAGENA
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 1:2202 N LOIS AVE APT 1418
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-2562
Mailing Address - Country:US
Mailing Address - Phone:407-460-2247
Mailing Address - Fax:
Practice Address - Street 1:2202 N LOIS AVE APT 1418
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-2562
Practice Address - Country:US
Practice Address - Phone:407-460-2247
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-01
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA71692225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist