Healthcare Provider Details

I. General information

NPI: 1265875058
Provider Name (Legal Business Name): LISANDRA SUAREZ
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2013
Last Update Date: 04/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR. 10 KM 75.6 BO HATO VIEJO SOLAR #1
ARECIBO PUERTO RICO
00612
UM

IV. Provider business mailing address

PO BOX 2170
UTUADO PR
00641-2194
US

V. Phone/Fax

Practice location:
  • Phone: 787-816-2600
  • Fax: 787-816-2600
Mailing address:
  • Phone: 787-816-2600
  • Fax: 787-816-2600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number1274
License Number StatePR

VIII. Authorized Official

Name: MRS. LISANDRA SUAREZ
Title or Position: OWNER
Credential: M.T.
Phone: 787-816-2600