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General NPI Number Information
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NPI Number | 1174595011
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Entity Type | Organization
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Legal Business Name | LABORATORIO CLINICO MILLENNIUM CSP
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Dates
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Enumeration Date | 02/04/2006
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Last Update Date | 05/11/2023
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Provider Practice Location Address
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Address Line | 449 CARR 3 URB. BUSO CALLE MARGINAL #5
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City | HUMACAO
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State | PR
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Zip | 00791-4635
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Country | US
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Telephone | 787-285-0588
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Fax | 787-285-0568
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Provider Business Mailing Address
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Address Line | PO BOX 9077
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City | HUMACAO
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State | PR
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Zip | 00792-9077
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Country | US
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Telephone | 787-285-0588
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Fax | 787-285-0568
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Authorized Official
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Title or Position | LAB DIRECTOR
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Name | MRS. MARIA IVETTE DIAZ
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Credential | M.T
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Telephone | 787-285-0588
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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 | 2158
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License Number State | PR
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