Healthcare Provider Details

I. General information

NPI: 1093830093
Provider Name (Legal Business Name): SERVICIOS MEDICOS DEL VALLE DE LAJAS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 04/29/2020
Certification Date: 04/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

237 AVE LOS VETERANOS
LAJAS PR
00667-2509
US

IV. Provider business mailing address

PO BOX 1715
LAJAS PR
00667-1715
US

V. Phone/Fax

Practice location:
  • Phone: 787-899-4242
  • Fax: 787-899-8023
Mailing address:
  • Phone: 787-899-4242
  • Fax: 787-899-8023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number816
License Number StatePR

VIII. Authorized Official

Name: ROBERTO I RUIZ
Title or Position: PRESIDENT
Credential: MHSA
Phone: 787-899-4242