Healthcare Provider Details

I. General information

NPI: 1568452522
Provider Name (Legal Business Name): SAHUDY AMADOR LOPEZ/DBA LABORATORIO CLINICO MOLDONADO AVILES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 07/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

#131 MUNOZ RIVERA
HATILLO PR
00659
US

IV. Provider business mailing address

47 URB VISTA VERDE
CAMUY PR
00627-3302
US

V. Phone/Fax

Practice location:
  • Phone: 787-898-2106
  • Fax: 787-898-2106
Mailing address:
  • Phone: 787-898-2106
  • Fax: 787-898-2106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number513
License Number StatePR

VIII. Authorized Official

Name: MRS. SAHUDY M AMADOR
Title or Position: DIRECTOR
Credential: MS, MT, ASCP
Phone: 787-898-2106