MEDICARE: LABORATORIO LARACUENTE LLC

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	:	1386233799
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LABORATORIO LARACUENTE LLC

Provider Business Mailing Address
First Line	:	291 CALLE MENDEZ VIGO
Second Line	:
City	:	DORADO
State	:	PR
Zip	:	00646-4913
Country	:	US
Telephone Number	:	787-796-1003
Fax Number	:

Provider Business Practice Location Address
First Line	:	291 CALLE MENDEZ VIGO
Second Line	:
City	:	DORADO
State	:	PR
Zip	:	00646-4913
Country	:	US
Telephone Number	:	787-796-1003
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	SONIA LARACUENTE
Credential	:	MT
Telephone Number	:	787-796-1003

Provider Enumeration Date	:	01/12/2021
Last Update Date	:	06/21/2021

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