Healthcare Provider Details

I. General information

NPI: 1699944090
Provider Name (Legal Business Name): MARIA LOUISA CRESPO MT(ASCP)
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LABORATORIO CLINICO BACTERIOLOGICO SAN ANTONIO

II. Dates (important events)

Enumeration Date: 02/29/2008
Last Update Date: 06/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1065 AVE GENERAL RAMEY SUITE 1
SAN ANTONIO PR
00690-1117
US

IV. Provider business mailing address

PO BOX 791
SAN ANTONIO PR
00690-0791
US

V. Phone/Fax

Practice location:
  • Phone: 787-890-6161
  • Fax: 787-890-6161
Mailing address:
  • Phone: 787-890-6161
  • Fax: 787-890-6161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number761
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code246QM0706X
TaxonomyMedical Technologist
License Number2870
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: