Healthcare Provider Details

I. General information

NPI: 1427911718
Provider Name (Legal Business Name): TERESITA LAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2025
Last Update Date: 12/04/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE JESUS T PINERO
SAN JUAN PR
00927-6704
US

IV. Provider business mailing address

MIRABELLA VILLAGE CALLE CUARZO 23A
BAYAMON PR
00961
US

V. Phone/Fax

Practice location:
  • Phone: 787-675-0112
  • Fax:
Mailing address:
  • Phone: 787-675-0112
  • Fax: 787-675-0112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: JESSICA Z GONZALEZ QUIJANO
Title or Position: CEO
Credential:
Phone: 787-675-0112