MEDICARE: LABORATORIO CLINICO GORDO

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	105	PR

General Provider Information

NPI Number	:	1447428974
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LABORATORIO CLINICO GORDO

Provider Business Mailing Address
First Line	:	71 CALLE CARAZO
Second Line	:
City	:	GUAYNABO
State	:	PR
Zip	:	00969-5700
Country	:	US
Telephone Number	:	787-720-3643
Fax Number	:	787-272-0833

Provider Business Practice Location Address
First Line	:	71 CALLE CARAZO
Second Line	:
City	:	GUAYNABO
State	:	PR
Zip	:	00969-5700
Country	:	US
Telephone Number	:	787-720-3643
Fax Number	:	787-272-0833

Authorized Official
Title or Position	:	DIRECTOR
Name	:	LILLIAN MARIA GORDO
Credential	:	MT
Telephone Number	:	787-720-3643

Provider Enumeration Date	:	02/19/2008
Last Update Date	:	02/19/2008

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Directions to “LABORATORIO CLINICO GORDO ” Practice Location

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