Healthcare Provider Details

I. General information

NPI: 1578705034
Provider Name (Legal Business Name): LABORATORIO CLINICO AVANZADO EMMANUEL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2009
Last Update Date: 03/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 149 # KM3.0 BO COTTO SUR
MANATI PR
00674-9670
US

IV. Provider business mailing address

36 CALLE SIERRA BERDECIA URB LUCHETTI
MANATI PR
00674-6016
US

V. Phone/Fax

Practice location:
  • Phone: 787-346-1696
  • Fax:
Mailing address:
  • Phone: 787-346-1696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number40D1090756
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. YAHAIRA ENID ROMERO
Title or Position: VICE PRESIDENT
Credential: M.T.
Phone: 787-346-1696