=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174532568
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LABORATORIO CLINICO LA CUMBRE, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/05/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 264 CALLE SIERRA MORENA URB. LA CUMBRE
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00926-5539
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-720-7788
-----------------------------------------------------
Fax | 787-287-6495
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | AVE PONCE DE LEON #662
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00918-1000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-720-7788
-----------------------------------------------------
Fax | 787-287-6495
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. JOSE O ALSINA
-----------------------------------------------------
Credential | LIC.
-----------------------------------------------------
Telephone | 787-720-7788
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number | 505
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------