Healthcare Provider Details

I. General information

NPI: 1679020481
Provider Name (Legal Business Name): LISAMAR ROLON GUZMAN MT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2016
Last Update Date: 09/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

A10 CALLE 1 VILLA MATILDE
TOA ALTA PR
00953
US

IV. Provider business mailing address

A10 CALLE 1 VILLA MATILDE
TOA ALTA PR
00953-2304
US

V. Phone/Fax

Practice location:
  • Phone: 787-870-2200
  • Fax:
Mailing address:
  • Phone: 787-870-2200
  • Fax:

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:
Title or Position:
Credential:
Phone: