Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | ME84557 | FL |
NPI | 1003875188 |
---|---|
Provider Name | Zulma Nahir Laracuente |
First Address | Tampa, FL 33614-7100 |
Second Address | Tampa, FL 33615-2754 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
BL7777951 | DEA (01) | FL |