Provider Demographics
NPI:1457521684
Name:LARACUENTE ROSADO, ILEANA
Entity Type:Individual
Prefix:
First Name:ILEANA
Middle Name:
Last Name:LARACUENTE ROSADO
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:PO BOX 71474
Mailing Address - Street 2:APS HEALTHCARE PR
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-8574
Mailing Address - Country:US
Mailing Address - Phone:787-641-0774
Mailing Address - Fax:787-641-0776
Practice Address - Street 1:AVE. TEJAS 90 KM. 5
Practice Address - Street 2:APS CLINICS PR
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791
Practice Address - Country:US
Practice Address - Phone:787-641-0774
Practice Address - Fax:787-641-0776
Is Sole Proprietor?:No
Enumeration Date:2008-03-04
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1619103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical