Healthcare Provider Details

I. General information

NPI: 1417915182
Provider Name (Legal Business Name): LABORATORIO CLINICO CDT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CALLE TOMAS DAVILA
BARCELONETA PR
00617-2736
US

IV. Provider business mailing address

PO BOX 359
BARCELONETA PR
00617-0359
US

V. Phone/Fax

Practice location:
  • Phone: 787-846-6890
  • Fax: 787-846-5458
Mailing address:
  • Phone: 787-846-6890
  • Fax: 787-846-5458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number629
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: CDT RIVERA LABARCA RIVERA LABARCA
Title or Position: OWNERS
Credential: 30656
Phone: 787-846-6890