Healthcare Provider Details

I. General information

NPI: 1083609556
Provider Name (Legal Business Name): IRMARIL PEREZ SANTONI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2005
Last Update Date: 11/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

178 CALLE COLON
AGUADA PR
00602-3222
US

IV. Provider business mailing address

CALLE COLON 118
AGUADA PUERTO RICO
00602
UM

V. Phone/Fax

Practice location:
  • Phone: 787-868-2450
  • Fax:
Mailing address:
  • Phone: 787-868-2450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number814
License Number StatePR

VIII. Authorized Official

Name: IRMARIL PEREZ
Title or Position: OWNER
Credential: MT
Phone: 787-868-2450