MEDICARE: QUEST DIAGNOSTICS OF PUERTO RICO, INC

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

General Provider Information

NPI Number	:	1376136069
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUEST DIAGNOSTICS OF PUERTO RICO, INC

Provider Business Mailing Address
First Line	:	107 AVE ORTEGON STE 103
Second Line	:
City	:	GUAYNABO
State	:	PR
Zip	:	00966-2516
Country	:	US
Telephone Number	:	787-474-2900
Fax Number	:	787-765-5663

Provider Business Practice Location Address
First Line	:	85 CALLE DON CHEMARY
Second Line	:
City	:	MOCA
State	:	PR
Zip	:	00676-4120
Country	:	US
Telephone Number	:	787-474-2900
Fax Number	:	787-765-5663

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	OMAYRA ESPINOSA
Credential	:
Telephone Number	:	787-474-2900

Provider Enumeration Date	:	02/15/2021
Last Update Date	:	02/15/2021

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