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General NPI Number Information
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NPI Number | 1124164140
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Entity Type | Organization
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Legal Business Name | LABORATORIO CLINICO COVADONGA,INC
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Dates
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Enumeration Date | 01/29/2007
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Last Update Date | 08/30/2007
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Provider Practice Location Address
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Address Line | AA4 AVE DON PELAYO HACIENDAS DEL NORTE
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City | TOA BAJA
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State | PR
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Zip | 00949-5388
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Country | US
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Telephone | 787-251-0138
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Fax | 787-251-0130
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Provider Business Mailing Address
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Address Line | AA4 AVE DON PELAYO HACIENDAS DEL NORTE
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City | TOA BAJA
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State | PR
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Zip | 00949-5388
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Country | US
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Telephone | 787-251-0138
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Fax | 787-251-0130
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Authorized Official
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Title or Position | SUPERVISOR
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Name | MRS. LILLIAN SANTIAGO
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Credential | MT
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Telephone | 787-251-0138
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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 | 00758
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License Number State | PR
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