Provider Demographics
NPI:1356057103
Name:LAJARA, ASTRID GISELLE (MD)
Entity type:Individual
Prefix:
First Name:ASTRID
Middle Name:GISELLE
Last Name:LAJARA
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:Y-35 BLVD MONROIG
Mailing Address - Street 2:LEVITTOWN
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949
Mailing Address - Country:US
Mailing Address - Phone:787-210-9859
Mailing Address - Fax:
Practice Address - Street 1:Y-35 BLVD MONROIG
Practice Address - Street 2:LEVITTOWN
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949-0094
Practice Address - Country:US
Practice Address - Phone:787-210-9859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-25
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR001198-PA208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice