Healthcare Provider Details

I. General information

NPI: 1851599708
Provider Name (Legal Business Name): QJP LABORATORY SERVICE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 08/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ROAD 2 KM 67 HM 7 INT SANTANA ZONA INDUSTRIAL
ARECIBO PR
00612
US

IV. Provider business mailing address

PO BOX 1064
ARECIBO PR
00613-1064
US

V. Phone/Fax

Practice location:
  • Phone: 787-881-2828
  • Fax: 878-881-2828
Mailing address:
  • Phone: 787-881-2828
  • Fax: 787-881-2828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number1123
License Number StatePR

VIII. Authorized Official

Name: MRS. QUIOMARI J PEREZ
Title or Position: MEDICAL TECHNOLOGIST
Credential: MT
Phone: 787-201-7794