Provider Demographics
NPI:1295769875
Name:OJEDA-LARACUENTE, WINSTON (MD)
Entity type:Individual
Prefix:DR
First Name:WINSTON
Middle Name:
Last Name:OJEDA-LARACUENTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 CORAZONES AVE.
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680
Mailing Address - Country:US
Mailing Address - Phone:787-834-5334
Mailing Address - Fax:787-833-6640
Practice Address - Street 1:1050 CORAZONES AVE.
Practice Address - Street 2:SUITE 102
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-834-5334
Practice Address - Fax:787-833-6640
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3425174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty