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General NPI Number Information
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NPI Number | 1083919575
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Entity Type | Organization
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Legal Business Name | LABORATORIO CLINICO ELY
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Dates
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Enumeration Date | 01/14/2011
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Last Update Date | 04/11/2011
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Provider Practice Location Address
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Address Line | 33 AVE HOSTOS ESQUINA PADRE NOEL
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City | PONCE
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State | PR
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Zip | 00716
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Country | US
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Telephone | 787-974-9556
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Fax |
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Provider Business Mailing Address
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Address Line | JARDINES DEL CARIBE CALLE 37 JJ 33
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City | PONCE
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State | PR
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Zip | 00728
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Country | US
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Telephone | 787-974-9556
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | YAIRA VARGAS MARTINEZ
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Credential |
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Telephone | 787-974-9556
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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 |
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License Number State | PR
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