Healthcare Provider Details

I. General information

NPI: 1588730923
Provider Name (Legal Business Name): LABORATORIO CLINICO DEL PARQUE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 07/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

352 CALLE DEL PARQUE
SAN JUAN PR
00912-3702
US

IV. Provider business mailing address

PO BOX 41028
SAN JUAN PR
00940-1028
US

V. Phone/Fax

Practice location:
  • Phone: 787-724-4161
  • Fax: 787-724-4161
Mailing address:
  • Phone: 787-724-4161
  • Fax: 787-724-4161

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: CARLOS M HIRALDO
Title or Position: DIRECTOR
Credential: TECNOLOGO MEDICO
Phone: 787-724-4161