Healthcare Provider Details

I. General information

NPI: 1093708729
Provider Name (Legal Business Name): LABORATORIO CLINICO SANGERMENO PRINCIPAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2005
Last Update Date: 09/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 CALLE PRINCIPAL URB . EL RETIRO
SAN GERMAN PR
00683-4447
US

IV. Provider business mailing address

PO BOX 3008
SAN GERMAN PR
00683-3008
US

V. Phone/Fax

Practice location:
  • Phone: 787-892-0635
  • Fax: 787-892-7385
Mailing address:
  • Phone: 787-892-0635
  • Fax: 787-892-7385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number971
License Number StatePR

VIII. Authorized Official

Name: GLORIA D TORRES
Title or Position: DIRECTOR
Credential: LCDA, MSMT
Phone: 787-892-0635