Provider Demographics
NPI:1831231497
Name:LAUREANO, LYDIA
Entity type:Individual
Prefix:MRS
First Name:LYDIA
Middle Name:
Last Name:LAUREANO
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 1:271 AVE BARBOSA
Mailing Address - Street 2:HATO REY
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00917-3310
Mailing Address - Country:US
Mailing Address - Phone:787-753-7356
Mailing Address - Fax:787-767-8100
Practice Address - Street 1:271 AVE BARBOSA
Practice Address - Street 2:HATO REY
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917-3310
Practice Address - Country:US
Practice Address - Phone:787-753-7356
Practice Address - Fax:787-767-8100
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3818183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist