Healthcare Provider Details

I. General information

NPI: 1750370151
Provider Name (Legal Business Name): LAB CLIN Y PACT SABANA SECA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 07/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE.RAMON RIOS ROMAN ESQ.AVE.866 P59B
SABANA SECA TOA BAJA PR
00952-0929
US

IV. Provider business mailing address

PO BOX 929
SABANA SECA PR
00952-0929
US

V. Phone/Fax

Practice location:
  • Phone: 787-795-1080
  • Fax: 787-795-1080
Mailing address:
  • Phone: 787-795-1080
  • Fax: 787-795-1080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number944
License Number StatePR

VIII. Authorized Official

Name: MS. ELSIE CRUZ
Title or Position: MEDICAL TECHNOLOGYST /SUPERIVSOR
Credential: M.T.
Phone: 787-795-1080