Healthcare Provider Details

I. General information

NPI: 1992119804
Provider Name (Legal Business Name): QUEST DIAGNOSTICS OF PUERTO RICO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2014
Last Update Date: 06/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 ROAD 865 INTERIOR BARRIO CANDELARIA
TOA BAJA PR
00949-5710
US

IV. Provider business mailing address

1001 ADAMS AVE MRGOV 2ND FLOOR
NORRISTOWN PA
19403-2429
US

V. Phone/Fax

Practice location:
  • Phone: 787-474-2900
  • Fax: 787-765-5663
Mailing address:
  • Phone: 484-676-7000
  • 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: J PABLO LAKE
Title or Position: VP REVENUE SERVICES
Credential:
Phone: 484-676-7737