Healthcare Provider Details

I. General information

NPI: 1154398113
Provider Name (Legal Business Name): BORINQUEN LABORATORY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 02/28/2025
Certification Date: 02/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

349 FELISA RINCON DE GAUTIER PASEO LAS CUMBRES SHOPPING CENTER SUITE 105
SAN JUAN PR
00926
US

IV. Provider business mailing address

PO BOX 14334
SAN JUAN PR
00916-4334
US

V. Phone/Fax

Practice location:
  • Phone: 787-999-2797
  • Fax: 787-999-2798
Mailing address:
  • Phone: 787-999-2797
  • Fax: 787-999-2798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number1061
License Number StatePR

VIII. Authorized Official

Name: LINA I GARCIA
Title or Position: OWNER
Credential: MT/ASCP
Phone: 787-999-2797