Healthcare Provider Details

I. General information

NPI: 1982931317
Provider Name (Legal Business Name): CARLOS J FEBLES MENA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2009
Last Update Date: 05/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR# 693 KM 8.4 MARGINAL COSTA DE ORO LOCAL A-6
DORADO PR
00646
US

IV. Provider business mailing address

M10 CALLE ESTRELLA DEL MAR DORADO DEL MAR
DORADO PR
00646-2147
US

V. Phone/Fax

Practice location:
  • Phone: 787-796-2282
  • Fax: 787-796-8086
Mailing address:
  • Phone: 787-796-2282
  • Fax: 787-796-8086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number993
License Number StatePR

VIII. Authorized Official

Name: MR. CARLOS J. FEBLES
Title or Position: OWNER
Credential:
Phone: 787-796-2282