Healthcare Provider Details

I. General information

NPI: 1205701430
Provider Name (Legal Business Name): SUPER LAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2025
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 AVE ANTONIO R BARCELO APT 202A
CAYEY PR
00736-5594
US

IV. Provider business mailing address

224 CALLE HIMALAYA
SAN JUAN PR
00926-1414
US

V. Phone/Fax

Practice location:
  • Phone: 787-545-0591
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2080S0012X
TaxonomyPediatric Sleep Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID DE ANGEL SOLA
Title or Position: PRESIDENT
Credential: MD
Phone: 787-632-3445