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General NPI Number Information
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NPI Number | 1154603546
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Entity Type | Organization
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Legal Business Name | WAXALI INC
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Dates
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Enumeration Date | 09/13/2011
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Last Update Date | 05/12/2014
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Provider Practice Location Address
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Address Line | RIO DEL PLATA MALL,URB JARDINES DE TOA ALTA,CALLE # 1 SUITE # 8
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City | TOA ALTA
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State | PR
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Zip | 00953
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Country | US
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Telephone | 787-545-3200
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Fax | 787-545-3201
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Provider Business Mailing Address
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Address Line | HC 72 BOX 3954
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City | NARANJITO
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State | PR
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Zip | 00719-8771
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Country | US
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Telephone | 787-869-1111
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Fax | 787-869-2318
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JOSE L COLLAZO-ROSADO
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Credential | MT
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Telephone | 787-869-1111
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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 | 1248
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License Number State | PR
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