Healthcare Provider Details

I. General information

NPI: 1902898380
Provider Name (Legal Business Name): ANA E CRESPO ROSA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 03/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE COLON #162
AGUADA PR
00602-3166
US

IV. Provider business mailing address

PO BOX 1092
AGUADA PR
00602-1092
US

V. Phone/Fax

Practice location:
  • Phone: 787-868-6080
  • Fax: 787-868-6080
Mailing address:
  • Phone: 787-868-6080
  • Fax: 787-868-6080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number495
License Number StatePR

VIII. Authorized Official

Name: MRS. ANA E. CRESPO
Title or Position: ADMINISTRATOR
Credential:
Phone: 787-868-6080