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General NPI Number Information
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NPI Number | 1013375591
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Entity Type | Organization
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Legal Business Name | BETA LAB
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Dates
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Enumeration Date | 01/29/2016
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Last Update Date | 01/29/2016
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Provider Practice Location Address
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Address Line | C/ 601 BLOQUE 222 # 18 VILLA CAROLINA
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City | CAROLINA
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State | PR
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Zip | 00985-2083
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Country | US
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Telephone | 787-613-1942
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Fax |
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Provider Business Mailing Address
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Address Line | COND. PLAZA DEL PARQUE ED 8 APT C-1
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City | CAROLINA
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State | PR
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Zip | 00983-2089
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Country | US
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Telephone | 787-613-1942
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Fax |
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Authorized Official
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Title or Position | MEDICAL TECHNOLOGIST
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Name | MARY CARMEN BETANCOURT
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Credential | M.T
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Telephone | 787-613-1942
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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 | 8263
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License Number State | PR
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