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General NPI Number Information
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NPI Number | 1114077955
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Entity Type | Organization
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Legal Business Name | LABORATORIO CLINICO DEL SURESTE
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Dates
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Enumeration Date | 01/12/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 34 CALLE LUIS MUNOZ RIVERA
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City | YABUCOA
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State | PR
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Zip | 00767-3110
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Country | US
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Telephone | 787-893-2595
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Fax | 787-893-2716
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Provider Business Mailing Address
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Address Line | PO BOX 1340
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City | YABUCOA
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State | PR
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Zip | 00767-1340
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Country | US
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Telephone | 787-893-2595
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Fax | 787-893-2716
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Authorized Official
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Title or Position | GENERAL SUPERVISOR
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Name | YANIRE CASTRO-TORRES
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Credential | MT
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Telephone | 787-893-2595
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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 | 569
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 216
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License Number State | PR
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