Healthcare Provider Details

I. General information

NPI: 1629064258
Provider Name (Legal Business Name): UNIVERSAL MEDICAL LABORATORIES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 06/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE. PONCE DE LEON ESQ. AVE. UNIVERSIDAD PLAZA UNIVERSITARIA LOCAL #7
SAN JUAN PR
00925
US

IV. Provider business mailing address

PO BOX 362842
SAN JUAN PR
00936-2842
US

V. Phone/Fax

Practice location:
  • Phone: 787-763-3992
  • Fax: 787-771-6592
Mailing address:
  • Phone: 787-763-3992
  • Fax: 787-771-6592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number264
License Number StatePR

VIII. Authorized Official

Name: MRS. YOLANDA COLON
Title or Position: ADMINISTRATOR
Credential:
Phone: 787-763-3992