Healthcare Provider Details

I. General information

NPI: 1043398241
Provider Name (Legal Business Name): CIDRA MEDICAL LABS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 03/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 CALLE GAUTIER BENITEZ
CIDRA PR
00739-3338
US

IV. Provider business mailing address

8 CALLE GAUTIER BENITEZ
CIDRA PR
00739-3338
US

V. Phone/Fax

Practice location:
  • Phone: 787-739-4747
  • Fax: 787-714-0522
Mailing address:
  • Phone: 787-739-4747
  • Fax: 787-714-0522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MRS. MYRNA GARCIA
Title or Position: LABORATORY DIRECTOR
Credential: BSMT ACSP
Phone: 787-747-7042