Healthcare Provider Details

I. General information

NPI: 1972660090
Provider Name (Legal Business Name): LABORATORIO CLINICO HOYAMALA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 06/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BO. HOYAMALA CARRETERA 119 KILOMETRO 28.7
SAN SEBASTIAN PR
00685
US

IV. Provider business mailing address

PO BOX 4617
SAN SEBASTIAN PR
00685-4617
US

V. Phone/Fax

Practice location:
  • Phone: 787-280-3543
  • Fax: 787-280-3543
Mailing address:
  • Phone: 787-280-3543
  • Fax: 787-280-3543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number862
License Number StatePR

VIII. Authorized Official

Name: MRS. MAYRA COLON
Title or Position: MEDICAL TECHNOLOGIST
Credential: M.T.
Phone: 787-280-3543