MEDICARE: MS. MARIA LOUISA CRESPO MT(ASCP)

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	761	PR
2	246QM0706X	Medical Technologist	2870	PR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	5599	OTHER	PR	AMERICAN HEALTH MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	051502	OTHER	PR	BLUE CROSS
2	800386	OTHER	PR	MMM
3	LA 0179	OTHER	PR	PAN AMERICAN LIFE
5	6030045	OTHER	PR	HUMANA HEALTH INS
6	0152	OTHER	PR	INTERNATIONAL MEDICAL CARD
7	30731	OTHER	PR	SSS
8	A0170	OTHER	PR	FIRST PLUS

General Provider Information

NPI Number	:	1699944090
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARIA LOUISA CRESPO MT(ASCP)

Provider Business Mailing Address
First Line	:	PO BOX 791
Second Line	:
City	:	SAN ANTONIO
State	:	PR
Zip	:	00690-0791
Country	:	US
Telephone Number	:	787-890-6161
Fax Number	:	787-890-6161

Provider Business Practice Location Address
First Line	:	1065 AVE GENERAL RAMEY
Second Line	:	SUITE 1
City	:	SAN ANTONIO
State	:	PR
Zip	:	00690-1117
Country	:	US
Telephone Number	:	787-890-6161
Fax Number	:	787-890-6161

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

Provider Enumeration Date	:	02/29/2008
Last Update Date	:	06/27/2008

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Directions to “ MS. MARIA LOUISA CRESPO MT(ASCP)” Practice Location

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