Provider Demographics
NPI:1376033779
Name:FREDES, LAURA MARCELA (MD)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:MARCELA
Last Name:FREDES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:LAURA
Other - Middle Name:MARCELA
Other - Last Name:ADRIANZEN FLOREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1017 LA SALLE LN
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-1368
Mailing Address - Country:US
Mailing Address - Phone:646-808-9186
Mailing Address - Fax:
Practice Address - Street 1:536 SILICON DR STE 102
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-9020
Practice Address - Country:US
Practice Address - Phone:817-203-4179
Practice Address - Fax:817-259-2793
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-11
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012789662084P0800X
NY3252252084P0800X
TXV03942084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty