Healthcare Provider Details

I. General information

NPI: 1154595965
Provider Name (Legal Business Name): LABORATORIO CLINICO COSTA ISABELA INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2008
Last Update Date: 09/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8494 AVE JOBOS # PMB120
ISABELA PR
00662-2143
US

IV. Provider business mailing address

8494 AVE JOBOS # PMB120
ISABELA PR
00662-2143
US

V. Phone/Fax

Practice location:
  • Phone: 787-872-4603
  • Fax: 787-872-4603
Mailing address:
  • Phone: 787-872-4603
  • Fax: 787-872-4603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MRS. GLENDA L LOPEZ
Title or Position: PRESIDENT
Credential: LCDA.
Phone: 787-872-4603