Healthcare Provider Details

I. General information

NPI: 1487029450
Provider Name (Legal Business Name): LABORATORIOS DEL SUENO DE PUERTO RICO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2015
Last Update Date: 12/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1845 CARR 2 STE 703 ROAD #2
BAYAMON PR
00959-7206
US

IV. Provider business mailing address

55 CALLE DE DIEGO E STE 405 CPR PROF. BLDG
MAYAGUEZ PR
00680-5082
US

V. Phone/Fax

Practice location:
  • Phone: 787-986-7010
  • Fax: 787-805-4477
Mailing address:
  • Phone: 787-778-5957
  • Fax: 787-778-5958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number516492
License Number StatePR

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MS. IVETTE OTERO
Title or Position: SECRETARY
Credential:
Phone: 787-986-7010