Healthcare Provider Details

I. General information

NPI: 1932186855
Provider Name (Legal Business Name): NILSA IVETTE SANCHEZ SHUMATE/LABORATORIO CLINICO MODELO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2005
Last Update Date: 09/13/2023
Certification Date: 06/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 AVE BARBOSA
CATANO PR
00962
US

IV. Provider business mailing address

PO BOX 598
CATANO PR
00963-0598
US

V. Phone/Fax

Practice location:
  • Phone: 787-788-1428
  • Fax: 787-788-2409
Mailing address:
  • Phone: 787-788-1428
  • Fax: 787-788-2409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number523
License Number StatePR

VIII. Authorized Official

Name: MRS. NILSA I SANCHEZ SHUMATE
Title or Position: OWNER
Credential: BA
Phone: 787-788-1428