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General NPI Number Information
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NPI Number | 1023000361
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Entity Type | Organization
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Legal Business Name | LABORATORIO CLINICO TINTILLO
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Dates
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Enumeration Date | 08/22/2005
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Last Update Date | 11/26/2007
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Provider Practice Location Address
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Address Line | 12 CALLE BUEN SAMARITANO JUAN DOMINGO
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City | GUAYNABO
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State | PR
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Zip | 00966-7934
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Country | US
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Telephone | 787-783-5686
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Fax | 787-707-0818
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Provider Business Mailing Address
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Address Line | PO BOX 194690
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City | SAN JUAN
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State | PR
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Zip | 00919-4690
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Country | US
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Telephone | 787-783-5686
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Fax | 787-707-0818
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. MARLEN J. POU
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Credential | BS, MT
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Telephone | 787-783-5686
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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 | 552
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License Number State | PR
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