Provider Demographics
NPI:1861415184
Name:LASANTA, DORIS GISELA (MD)
Entity type:Individual
Prefix:
First Name:DORIS
Middle Name:GISELA
Last Name:LASANTA
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:CAMINO DE VELARDE NH25
Mailing Address - Street 2:MANSION DEL NORTE
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949
Mailing Address - Country:US
Mailing Address - Phone:787-784-5284
Mailing Address - Fax:
Practice Address - Street 1:CALLE 42 L1 TURABO GARDENS V
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:786-747-2883
Practice Address - Fax:787-747-2883
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16367207Q00000X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR16367OtherMEDICAL LICENSE