Healthcare Provider Details

I. General information

NPI: 1033867593
Provider Name (Legal Business Name): QUEST DIAGNOSTICS OF PUERTO RICO, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2022
Last Update Date: 04/25/2022
Certification Date: 04/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARRETERA #2 KM 46.4 BO COTTO NORTE EDIFICIO LAS VEGAS
MANATI PR
00674
US

IV. Provider business mailing address

107 AVE ORTEGON STE 103
GUAYNABO PR
00966-2516
US

V. Phone/Fax

Practice location:
  • Phone: 787-474-2900
  • Fax: 787-765-5663
Mailing address:
  • Phone: 787-474-2900
  • Fax: 787-765-5663

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: OMAYRA ESPINOSA
Title or Position: BILLING MANAGER
Credential:
Phone: 787-474-2900