Provider Demographics
NPI:1902503337
Name:VICENTE NAZARIO LARACUENTE LLC
Entity Type:Organization
Organization Name:VICENTE NAZARIO LARACUENTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DUENO
Authorized Official - Prefix:DR
Authorized Official - First Name:VICENTE
Authorized Official - Middle Name:
Authorized Official - Last Name:NAZARIO LARACUENTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-361-7101
Mailing Address - Street 1:PO BOX 2412
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-2412
Mailing Address - Country:US
Mailing Address - Phone:787-361-7101
Mailing Address - Fax:
Practice Address - Street 1:PASEO LOS ROBLES CALLE RAMON QUILES 1307
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-361-7101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-15
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty