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General NPI Number Information
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NPI Number | 1053765354
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Entity Type | Organization
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Legal Business Name | LABORATORIO CLINICO SAN JUAN INC
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Dates
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Enumeration Date | 04/22/2016
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Last Update Date | 04/22/2016
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Provider Practice Location Address
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Address Line | 425 CARR 693 STE 1 PMB 132
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City | DORADO
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State | PR
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Zip | 00646-4817
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Country | US
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Telephone | 787-554-4272
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Fax |
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Provider Business Mailing Address
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Address Line | JL-32 AVENIDA CARLOS JAVIER ANDALUZ ROYAL PALM
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City | BAYAMON
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State | PR
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Zip | 00956-0000
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Country | US
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Telephone | 787-756-7128
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Fax |
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Authorized Official
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Title or Position | PRESIDENTE
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Name | MS. CARMEN L ARRIETA
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Credential |
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Telephone | 787-756-7128
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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 | 812
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License Number State | PR
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