Healthcare Provider Details

I. General information

NPI: 1396826780
Provider Name (Legal Business Name): MEDITEST DIAGNOSTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 CALLE DR PAVIA FERNANDEZ AVE. FERNANDEZ JUNCOS SUITE 201
SAN JUAN PR
00909-2758
US

IV. Provider business mailing address

PO BOX 8700
SAN JUAN PR
00910-0700
US

V. Phone/Fax

Practice location:
  • Phone: 787-726-3724
  • Fax: 787-726-3724
Mailing address:
  • Phone: 787-726-3724
  • Fax: 787-726-3724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number StatePR

VIII. Authorized Official

Name: MR. JUAN CARLOS ROBERT
Title or Position: ADMINISTRATOR
Credential:
Phone: 787-726-3724