Healthcare Provider Details

I. General information

NPI: 1467991182
Provider Name (Legal Business Name): LABORATORIO CLINICO PORTAL DEL SOL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2017
Last Update Date: 02/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 AVE JUAN HERNANDEZ ORTIZ
ISABELA PR
00662-3602
US

IV. Provider business mailing address

7 AVE JUAN HERNANDEZ ORTIZ
ISABELA PR
00662-3602
US

V. Phone/Fax

Practice location:
  • Phone: 787-872-3480
  • Fax: 787-872-3480
Mailing address:
  • Phone: 787-872-3480
  • Fax: 787-872-3480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number630
License Number StatePR

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MRS. SOLANGEL CRUZ VALLE
Title or Position: PRESIDENTE
Credential:
Phone: 17878723480