Provider Demographics
NPI:1275274979
Name:FAJARDO TURRENT, LAURA
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:FAJARDO TURRENT
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 1:63 SURFSIDE RD
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00791-6057
Mailing Address - Country:US
Mailing Address - Phone:786-208-5885
Mailing Address - Fax:
Practice Address - Street 1:19701 S TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-4818
Practice Address - Country:US
Practice Address - Phone:844-342-7935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program