Provider Demographics
NPI:1912102716
Name:LAUREANO, MIGUEL ANGEL (ATP)
Entity Type:Individual
Prefix:MR
First Name:MIGUEL
Middle Name:ANGEL
Last Name:LAUREANO
Suffix:
Gender:M
Credentials:ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MILAGROSA STREET 716
Mailing Address - Street 2:CANTERA
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00915-0000
Mailing Address - Country:US
Mailing Address - Phone:787-777-3535
Mailing Address - Fax:787-764-7004
Practice Address - Street 1:PEDIATRIC UNIVERSITY HOSPITAL THIRD FLOOR C
Practice Address - Street 2:MEDICAL CENTER
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00936-0000
Practice Address - Country:US
Practice Address - Phone:787-777-3535
Practice Address - Fax:787-764-7004
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-20
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider