Healthcare Provider Details

I. General information

NPI: 1174547483
Provider Name (Legal Business Name): LABORATORIO CLINICO EL MORRO, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 05/13/2022
Certification Date: 05/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 AVE SIMON MADERA
SAN JUAN PR
00924-2231
US

IV. Provider business mailing address

11 AVE SIMON MADERA
SAN JUAN PR
00924-2231
US

V. Phone/Fax

Practice location:
  • Phone: 787-753-4736
  • Fax: 939-338-1609
Mailing address:
  • Phone: 787-753-4736
  • Fax: 939-338-1609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number879
License Number StatePR

VIII. Authorized Official

Name: MIGUEL A RODRIGUEZ
Title or Position: OWNER
Credential:
Phone: 787-717-8152