Provider Demographics
NPI:1730566894
Name:CEDENO LACLAUSTRA MD PSC
Entity type:Organization
Organization Name:CEDENO LACLAUSTRA MD PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ENCAGADO CREDENCIALES Y DOCUMENTOS
Authorized Official - Prefix:MR
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:ZAPATA
Authorized Official - Last Name:MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:787-372-5251
Mailing Address - Street 1:P.O BOX 5103-216
Mailing Address - Street 2:
Mailing Address - City:CABO ROJO
Mailing Address - State:PR
Mailing Address - Zip Code:00623-5103
Mailing Address - Country:US
Mailing Address - Phone:787-237-1613
Mailing Address - Fax:787-652-1661
Practice Address - Street 1:CARR 311 KM 6.2
Practice Address - Street 2:B.O CERILLOS URB LAS VISTOS
Practice Address - City:CABO ROJO
Practice Address - State:PR
Practice Address - Zip Code:00623
Practice Address - Country:US
Practice Address - Phone:787-237-1613
Practice Address - Fax:787-652-1661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-28
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
E1240AMedicare PIN