=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124194527
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LABORATORIO BEIRO INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/28/2006
-----------------------------------------------------
Last Update Date | 09/12/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | CALLE PALMER #22 SUR
-----------------------------------------------------
City | GUAYAMA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00784-2878
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-864-1866
-----------------------------------------------------
Fax | 787-864-8654
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2878
-----------------------------------------------------
City | GUAYAMA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00785-2878
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-864-1866
-----------------------------------------------------
Fax | 787-864-8654
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENTE
-----------------------------------------------------
Name | LORENZO A BEIRO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 787-864-1866
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number | 164
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------