MEDICARE: UNIVERSAL MEDICAL LABORATORIES, 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	264	PR

General Provider Information

NPI Number	:	1629064258
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSAL MEDICAL LABORATORIES, INC.

Provider Business Mailing Address
First Line	:	PO BOX 362842
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00936-2842
Country	:	US
Telephone Number	:	787-763-3992
Fax Number	:	787-771-6592

Provider Business Practice Location Address
First Line	:	AVE. PONCE DE LEON ESQ. AVE. UNIVERSIDAD
Second Line	:	PLAZA UNIVERSITARIA LOCAL #7
City	:	SAN JUAN
State	:	PR
Zip	:	00925
Country	:	US
Telephone Number	:	787-763-3992
Fax Number	:	787-771-6592

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. YOLANDA COLON
Credential	:
Telephone Number	:	787-763-3992

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	06/13/2011

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