Healthcare Provider Details

I. General information

NPI: 1144224874
Provider Name (Legal Business Name): LBA MEDICAL SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2005
Last Update Date: 04/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 CALLE GUARAGUAO
SAN JUAN PR
00926-7101
US

IV. Provider business mailing address

145 CALLE GUARAGUAO
SAN JUAN PR
00926-7101
US

V. Phone/Fax

Practice location:
  • Phone: 787-760-6604
  • Fax: 787-292-0130
Mailing address:
  • Phone: 787-760-6604
  • Fax: 787-292-0130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number87071
License Number StatePR

VIII. Authorized Official

Name: DR. LORENZO E BOSQUE
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 787-760-6604