Healthcare Provider Details

I. General information

NPI: 1407301401
Provider Name (Legal Business Name): ST. THOMAS CLINICAL REFERENCE LABORATORY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2016
Last Update Date: 12/09/2024
Certification Date: 12/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MEDICAL COMPLEX SUITE NO. 9 ST THOMAS
ST THOMAS VI
00802-5735
US

IV. Provider business mailing address

MEDICAL COMPLEX SUITE NO. 3 ST THOMAS
ST THOMAS VI
00802-5735
US

V. Phone/Fax

Practice location:
  • Phone: 340-774-6256
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number1348871L
License Number StateVI

VIII. Authorized Official

Name: CARLOS A GONZALEZ
Title or Position: PRESIDENTE
Credential:
Phone: 787-246-4698