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Individual
LAURA REQUENEZ
Active
Individual
LAURA REQUENEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA09836
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
741679824
GROUP TAX ID
TX
01
—
742557428
GROUP TAX ID
TX
Enumeration date
03/23/2016
Last updated
10/28/2024
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