Provider Demographics
NPI:1386148641
Name:AZUETA, LAURA
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:AZUETA
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 1:92-23 244TH STREET
Mailing Address - Street 2:
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11001-3912
Mailing Address - Country:US
Mailing Address - Phone:516-725-3295
Mailing Address - Fax:
Practice Address - Street 1:39 E JERICHO TPKE
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-3196
Practice Address - Country:US
Practice Address - Phone:516-706-1740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-21
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist