Healthcare Provider Details

I. General information

NPI: 1417383183
Provider Name (Legal Business Name): QUEST DIAGNOSTICS OF PUERTO RICO, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2013
Last Update Date: 02/06/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

H44 CALLE MARGINAL URB. SANTA RITA
VEGA ALTA PR
00692-6713
US

IV. Provider business mailing address

107 CALLE ORTEGON, SUITE 105
GUAYNABO PR
00966-2516
US

V. Phone/Fax

Practice location:
  • Phone: 787-883-1271
  • Fax:
Mailing address:
  • Phone:
  • 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: LEAH D TIMMERMAN
Title or Position: VICE PRESIDENT
Credential:
Phone: 973-520-2700