Healthcare Provider Details

I. General information

NPI: 1831182070
Provider Name (Legal Business Name): LAB CLINICO BACTERIOLOGICO DEVAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 05/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 CARR 140
BARCELONETA PR
00617-2806
US

IV. Provider business mailing address

29 CARR 140 PO BOX 399
BARCELONETA PR
00617-2806
US

V. Phone/Fax

Practice location:
  • Phone: 787-846-0196
  • Fax: 787-846-0196
Mailing address:
  • Phone: 787-846-0196
  • Fax: 787-846-0196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number996
License Number StatePR

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MRS. DEBORAH I. TALAVERA
Title or Position: OWNER/GENERAL SUPERVISOR
Credential: M.T.
Phone: 787-846-0196