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General NPI Number Information
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NPI Number | 1144384256
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Entity Type | Organization
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Legal Business Name | ROSA M. HEREDIA CASTILLO
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Dates
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Enumeration Date | 12/21/2006
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Last Update Date | 05/30/2012
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Provider Practice Location Address
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Address Line | 260 AVE DE LA CONSTITUCION SUITE 101
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City | SAN JUAN
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State | PR
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Zip | 00901-2298
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Country | US
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Telephone | 787-722-0341
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Fax | 787-722-0341
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Provider Business Mailing Address
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Address Line | PO BOX 367331
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City | SAN JUAN
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State | PR
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Zip | 00936-7331
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Country | US
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Telephone | 787-722-0341
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Fax | 787-722-0341
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. ROSA M HEREDIA
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Credential | MT
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Telephone | 787-722-0341
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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 | 768
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License Number State | PR
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