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General NPI Number Information
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NPI Number | 1154782175
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Entity Type | Organization
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Legal Business Name | MI LABORATORIO CLINICO COOP
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Dates
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Enumeration Date | 03/18/2016
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Last Update Date | 03/18/2016
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Provider Practice Location Address
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Address Line | CARRETERA 115 KM 0.1 BARRIO ASOMANTE
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City | AGUADA
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State | PR
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Zip | 00602-3166
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Country | US
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Telephone | 787-868-3339
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Fax | 787-868-3339
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Provider Business Mailing Address
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Address Line | CALLE COLON # 118
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City | AGUADA
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State | PR
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Zip | 00602-3166
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Country | US
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Telephone | 787-868-3339
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Fax | 787-868-3339
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Authorized Official
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Title or Position | PRESIDENTE
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Name | ALEXIS A HENSON
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Credential |
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Telephone | 787-608-4600
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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 | 1169
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License Number State | PR
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