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General NPI Number Information
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NPI Number | 1063899342
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Entity Type | Organization
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Legal Business Name | LABORATORIO CLINICO SUNRISE BAY INC
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Dates
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Enumeration Date | 05/06/2015
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Last Update Date | 09/02/2015
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Provider Practice Location Address
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Address Line | 5900 AVE ISLA VERDE LOCAL #1
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City | CAROLINA
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State | PR
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Zip | 00979
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Country | US
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Telephone | 787-232-3231
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Fax | 787-653-7451
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Provider Business Mailing Address
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Address Line | PO BOX 367127 SAN JUAN STATION
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City | SAN JUAN
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State | PR
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Zip | 00936
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Country | US
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Telephone | 787-232-3231
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Fax | 787-653-7451
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. ANNIE ORTIZ
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Credential |
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Telephone | 787-232-3231
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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 | 1327
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License Number State | PR
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