MEDICARE: LABORATORIO CLINICO SANTA JUANITA, 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	:	1538725031
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LABORATORIO CLINICO SANTA JUANITA, INC

Provider Business Mailing Address
First Line	:	AL20 CALLE 30
Second Line	:
City	:	BAYAMON
State	:	PR
Zip	:	00956-4706
Country	:	US
Telephone Number	:	787-787-5440
Fax Number	:	787-740-0860

Provider Business Practice Location Address
First Line	:	AL20 CALLE 30
Second Line	:
City	:	BAYAMON
State	:	PR
Zip	:	00956-4706
Country	:	US
Telephone Number	:	787-787-5440
Fax Number	:	787-740-0860

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	JUAN A SERRANO
Credential	:
Telephone Number	:	787-787-5440

Provider Enumeration Date	:	05/10/2019
Last Update Date	:	07/08/2019

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