Healthcare Provider Details

I. General information

NPI: 1285726257
Provider Name (Legal Business Name): MARIA DE L OURDES PITRE CUEVAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 07/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR. 635 KM 2.4 BO. DOMINGUITO
ARECIBO PR
00612
US

IV. Provider business mailing address

PO BOX 9764 COTTO STATION
ARECIBO PR
00613-9764
US

V. Phone/Fax

Practice location:
  • Phone: 787-878-5324
  • Fax: 787-878-5324
Mailing address:
  • Phone: 787-878-5324
  • Fax: 787-878-5324

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number826
License Number StatePR

VIII. Authorized Official

Name: MRS. MARIA DE L. PITRE
Title or Position: MEDICAL TECHNOLOGIST
Credential: M.T.
Phone: 787-878-5324