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General NPI Number Information
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NPI Number | 1093941064
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Entity Type | Organization
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Legal Business Name | GLADYS MORENO RODRIGUEZ
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Dates
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Enumeration Date | 06/04/2009
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Last Update Date | 07/28/2009
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Provider Practice Location Address
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Address Line | CARRETERA # 1 KM. 26.9 SECTOR LA CHANGA , BARRIO RIO CANAS
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City | CAGUAS
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State | PR
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Zip | 00725-6163
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Country | US
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Telephone | 787-744-0777
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Fax | 787-744-0777
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Provider Business Mailing Address
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Address Line | T17 CALLE 10 URB. SANTA JUANA 3
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City | CAGUAS
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State | PR
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Zip | 00725-2079
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Country | US
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Telephone | 787-744-0777
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Fax | 787-744-0777
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Authorized Official
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Title or Position | MEDICAL TECHNOLOGIST- OWNER
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Name | MRS. GLADYS MORENO
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Credential | MT, ASCP
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Telephone | 787-744-0777
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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 | 1187
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License Number State | PR
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