MEDICARE: LABORATORIO CLINICO PROFESIONAL SAN MIGUEL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory	318	PR

General Provider Information

NPI Number	:	1346372844
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LABORATORIO CLINICO PROFESIONAL SAN MIGUEL

Provider Business Mailing Address
First Line	:	PO BOX 21394
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00928-1394
Country	:	US
Telephone Number	:	787-765-6069
Fax Number	:	787-765-6069

Provider Business Practice Location Address
First Line	:	112 CALLE ARZUAGA
Second Line	:	EDIFICIO MEDINA CENTER SUITE 905
City	:	SAN JUAN
State	:	PR
Zip	:	00925-3321
Country	:	US
Telephone Number	:	787-765-6069
Fax Number	:	787-765-6069

Authorized Official
Title or Position	:	MEDICAL TECHNOLOGIST
Name	:	MIRIAM GARCIA
Credential	:
Telephone Number	:	787-765-6069

Provider Enumeration Date	:	03/10/2007
Last Update Date	:	08/22/2020

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