Healthcare Provider Details

I. General information

NPI: 1821071564
Provider Name (Legal Business Name): MRS. HELEN SEGARRA DELTORO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2005
Last Update Date: 08/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8151 CALLE CONCORDIA LABORATORIO CONCORDIA LUGARO
PONCE PR
00717-1552
US

IV. Provider business mailing address

LAB CONCORDIA LUGARO CALLE CONCORDIA 8151 SUITE 2 EDIFICIO PROFESIONAL
PONCE PR
00717-1552
US

V. Phone/Fax

Practice location:
  • Phone: 787-852-3394
  • Fax: 787-852-3394
Mailing address:
  • Phone: 787-840-0985
  • Fax: 787-852-3394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RM2200X
TaxonomyMedical Laboratory Technician
License Number2700
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: