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General NPI Number Information
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NPI Number | 1174500698
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Entity Type | Organization
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Legal Business Name | LABORATORO CLINICO EXPRESO TRUJILLO ALTO INC
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Dates
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Enumeration Date | 12/27/2005
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Last Update Date | 09/09/2008
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Provider Practice Location Address
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Address Line | G1B CALLE FRONTERA URB. VILLA ANDALUCIA
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City | SAN JUAN
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State | PR
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Zip | 00926
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Country | US
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Telephone | 787-748-2580
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Fax | 787-292-7966
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Provider Business Mailing Address
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Address Line | 1353 CARRETERA NO 19 PMB # 364
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City | GUAYNABO
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State | PR
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Zip | 00966
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Country | US
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Telephone | 787-748-2580
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Fax | 787-292-7966
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Authorized Official
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Title or Position | PRESIDENT
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Name | EDWIN CARDONA
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Credential | MT
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Telephone | 787-748-4102
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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 | 750
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License Number State | PR
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