Healthcare Provider Details

I. General information

NPI: 1144302373
Provider Name (Legal Business Name): ADA A MONTERO BSMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 01/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1964 CALLE LOIZA
SAN JUAN PR
00911-1832
US

IV. Provider business mailing address

PO BOX 12366
SAN JUAN PR
00914-0366
US

V. Phone/Fax

Practice location:
  • Phone: 787-728-5085
  • Fax: 787-727-5243
Mailing address:
  • Phone: 787-728-5085
  • Fax: 787-727-5243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number529
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code247ZC0005X
TaxonomyClinical Laboratory Director (Non-physician)
License Number1605
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: