Provider Demographics
NPI:1982899399
Name:AVILES-MEDINA, LAURA LINNETTE (MD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:LINNETTE
Last Name:AVILES-MEDINA
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 1:10241 LAKE VISTA CT
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33076-4133
Mailing Address - Country:US
Mailing Address - Phone:954-683-1661
Mailing Address - Fax:
Practice Address - Street 1:1613 HARRISON PKWY
Practice Address - Street 2:STE 200
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33323-2896
Practice Address - Country:US
Practice Address - Phone:954-838-2371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-10
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR26695208000000X
FLME1107112080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics