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General NPI Number Information
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NPI Number | 1043447030
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Entity Type | Organization
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Legal Business Name | LABORATORIO CLINICO SONIA SEPULVEDA, INC
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Dates
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Enumeration Date | 06/17/2009
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Last Update Date | 12/04/2024
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Provider Practice Location Address
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Address Line | STREET 628 PEDRO VELAZQUEZ DIAZ SUITE B1 EDIFICIO AURORA
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City | PENUELAS
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State | PR
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Zip | 00624-0490
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Country | US
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Telephone | 787-836-2178
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Fax | 787-836-2255
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Provider Business Mailing Address
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Address Line | 628 PEDRO VELAZQUEZ DIAZ SUITE B1 EDIFICIO AURORA
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City | PENUELAS
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State | PR
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Zip | 00624-0490
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Country | US
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Telephone | 787-836-2178
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Fax | 787-836-2255
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. VIVIAN M GONZALEZ
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Credential | MT, ACSP
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Telephone | 787-836-2178
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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 | 347
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License Number State | PR
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