Healthcare Provider Details

I. General information

NPI: 1841256906
Provider Name (Legal Business Name): LABORATORIO CLINICO NAZARET
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 2 KM. 46.4 BO. COTTO NORTE
MANATI PR
00674-5765
US

IV. Provider business mailing address

PO BOX 4472
VEGA BAJA PR
00694-4472
US

V. Phone/Fax

Practice location:
  • Phone: 787-884-5252
  • Fax: 787-884-5252
Mailing address:
  • Phone: 787-884-5252
  • Fax: 787-884-5252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number1103
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. MICHELLE MERCADO
Title or Position: OWNER
Credential:
Phone: 787-884-5252