Provider Demographics
NPI:1871538462
Name:LARACUENTE, RITA (MD)
Entity type:Individual
Prefix:
First Name:RITA
Middle Name:
Last Name:LARACUENTE
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 1:14325 BENDING BRANCH CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32824-6346
Mailing Address - Country:US
Mailing Address - Phone:407-855-9905
Mailing Address - Fax:407-857-2486
Practice Address - Street 1:14325 BENDING BRANCH CT
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32824-6346
Practice Address - Country:US
Practice Address - Phone:407-855-9905
Practice Address - Fax:407-857-2486
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-18
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME70410208D00000X
PR8378208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF87507Medicare UPIN