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General NPI Number Information
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NPI Number | 1114464229
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Entity Type | Organization
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Legal Business Name | LABORATORIO CLINICO LOS PUERTOS INC.
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Dates
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Enumeration Date | 01/26/2017
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Last Update Date | 10/29/2021
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Provider Practice Location Address
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Address Line | 67 CARR 691 COMM LOS PUERTOS BO HIGULLAR
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City | DORADO
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State | PR
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Zip | 00646
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Country | US
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Telephone | 787-466-8478
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Fax |
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Provider Business Mailing Address
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Address Line | DB15 CALLE LAGO PATILLAS URB LEVITTOWN
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City | TOA BAJA
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State | PR
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Zip | 00949
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Country | US
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Telephone | 787-466-8478
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Fax |
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Authorized Official
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Title or Position | RESIDENT AGENT
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Name | MR. ALEXADRA LOPEZ
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Credential |
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Telephone | 787-466-8478
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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 |
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