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General NPI Number Information
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NPI Number | 1073879425
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Entity Type | Organization
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Legal Business Name | LABORATORIO CLINICO TIAGO INC.
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Dates
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Enumeration Date | 04/10/2012
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Last Update Date | 06/19/2012
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Provider Practice Location Address
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Address Line | URB. SAN FELIZ CALLE 1 NUM A-2
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City | COROZAL
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State | PR
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Zip | 00783
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Country | US
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Telephone | 787-859-1823
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Fax | 787-859-1823
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Provider Business Mailing Address
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Address Line | RR 2 BOX 5634
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City | TOA ALTA
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State | PR
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Zip | 00953-8956
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Country | US
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Telephone | 787-859-1823
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Fax | 787-859-1823
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. LIZBETH DIAZ
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Credential | MT
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Telephone | 787-859-1823
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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 | 1253
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License Number State | PR
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