MEDICARE: MARLEN J POU

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	552	PR

General Provider Information

NPI Number	:	1548431067
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARLEN J POU

Provider Business Mailing Address
First Line	:	PO BOX 194690
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00919-4690
Country	:	US
Telephone Number	:	787-783-5686
Fax Number	:	787-707-0818

Provider Business Practice Location Address
First Line	:	12 CALLE BUEN SAMARITANO
Second Line	:	BO J DOMINGO
City	:	GUAYNABO
State	:	PR
Zip	:	00966-7934
Country	:	US
Telephone Number	:	787-783-5686
Fax Number	:	787-707-0818

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/13/2008
Last Update Date	:	09/17/2008

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Directions to “ MARLEN J POU ” Practice Location

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