Healthcare Provider Details

I. General information

NPI: 1083982557
Provider Name (Legal Business Name): GUAYNABO HEALTH PROVIDERS, CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2011
Last Update Date: 12/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 AVE LAS CUMBRES GUAYNABO MEDICAL MALL
GUAYNABO PR
00969-5523
US

IV. Provider business mailing address

PMB 205 PO BOX 70344
SAN JUAN PR
00936-8344
US

V. Phone/Fax

Practice location:
  • Phone: 787-720-5050
  • Fax: 787-720-4949
Mailing address:
  • Phone: 787-720-5050
  • Fax: 787-720-4949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number3
License Number StatePR

VIII. Authorized Official

Name: LILIANA MEDINA OTERO
Title or Position: PRESIDENT
Credential:
Phone: 787-720-5050