Healthcare Provider Details

I. General information

NPI: 1427335413
Provider Name (Legal Business Name): MEDICAL PHARMACY & LABORATORY ADMINISTRATIVE SERVICES CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2011
Last Update Date: 11/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE FLOR ANTILLANA RESIDENCIAL LUIS LLORENS TORRES
SAN JUAN PR
00923
US

IV. Provider business mailing address

PO BOX 51991
TOA BAJA PR
00950-1991
US

V. Phone/Fax

Practice location:
  • Phone: 787-707-1983
  • Fax: 787-277-1559
Mailing address:
  • Phone: 787-707-1983
  • Fax: 787-277-1559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MIGUEL A. ROBLEDO
Title or Position: PRESIDENT
Credential: MD
Phone: 787-707-1983