Healthcare Provider Details

I. General information

NPI: 1790951085
Provider Name (Legal Business Name): LILLY JADETTE TORRES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2008
Last Update Date: 05/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PARC EL TUQUE 523 CALLE RAMOS ANTONINI STE 1 LABORATORIO CLINICO EL TUQUE
PONCE PR
00728-4811
US

IV. Provider business mailing address

PARC EL TUQUE 523 CALLE RAMOS ANTONINI STE 1 LABORATORIO CLINICO EL TUQUE
PONCE PR
00728-4811
US

V. Phone/Fax

Practice location:
  • Phone: 787-259-1339
  • Fax: 787-259-1339
Mailing address:
  • Phone: 787-259-1339
  • Fax: 787-259-1339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246QM0706X
TaxonomyMedical Technologist
License Number1920
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code247ZC0005X
TaxonomyClinical Laboratory Director (Non-physician)
License Number
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number714
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: