Healthcare Provider Details

I. General information

NPI: 1689163594
Provider Name (Legal Business Name): MIRELYS NIEVES DELGADO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2018
Last Update Date: 05/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARRETERA 635 KM 2.4 BO. DOMINGUITO
ARECIBO PR
00612
US

IV. Provider business mailing address

PO BOX 9211
ARECIBO PR
00613-9211
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: MR. DAVID CORTES
Title or Position: ACCOUNTANT
Credential:
Phone: 787-878-5324