Healthcare Provider Details

I. General information

NPI: 1649396862
Provider Name (Legal Business Name): SERVICIOS MEDICOS LAS MARIAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 10/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE. LUCCETTI #9
MARICAO PR
00606
US

IV. Provider business mailing address

AVE. LUCCETTI #9
MARICAO PR
00606
US

V. Phone/Fax

Practice location:
  • Phone: 787-827-2230
  • Fax: 787-827-4155
Mailing address:
  • Phone: 787-827-2230
  • Fax: 787-827-4155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number903
License Number StatePR

VIII. Authorized Official

Name: URIEL LABOY
Title or Position: IT MANGER
Credential:
Phone: 787-827-2230