Healthcare Provider Details

I. General information

NPI: 1497863575
Provider Name (Legal Business Name): MEDICAL PHARMACY & LABORATORY ADMINISTRATIVE SERVICE CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE 8 ESQ 45 PARCELA FALU
RIO PIEDRA PR
00925
US

IV. Provider business mailing address

CALLE 8 ESQ 45 PARCELA FALU
RIO PIEDRA PR
00925
US

V. Phone/Fax

Practice location:
  • Phone: 787-763-3332
  • Fax:
Mailing address:
  • Phone: 787-763-3332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code281P00000X
TaxonomyChronic Disease Hospital
License Number
License Number State

VIII. Authorized Official

Name: MIGUEL ROBLEDO GOMEZ
Title or Position: PRESIDENTE
Credential:
Phone: 787-707-1983