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General NPI Number Information
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NPI Number | 1003364134
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Entity Type | Organization
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Legal Business Name | RICHARD MIRANDA RODRIGUEZ
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Dates
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Enumeration Date | 09/19/2016
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Last Update Date | 01/09/2017
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Provider Practice Location Address
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Address Line | CARR. PR-165 A10 CALLE 1 VILLA MATILDE
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City | TOA ALTA
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State | PR
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Zip | 00953-2304
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Country | US
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Telephone | 787-870-2200
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Fax |
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Provider Business Mailing Address
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Address Line | A10 CALLE 1 VILLA MATILDE
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City | TOA ALTA
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State | PR
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Zip | 00953-2304
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Country | US
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Telephone | 787-870-2200
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. RICHARD MIRANDA RODRIGUEZ
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Credential |
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Telephone | 787-870-2200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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