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General NPI Number Information
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NPI Number | 1174924393
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Entity Type | Organization
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Legal Business Name | LABORATORIO CLINICO CDT TOA ALTA
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Dates
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Enumeration Date | 09/08/2014
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Last Update Date | 09/08/2014
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Provider Practice Location Address
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Address Line | 16 CALLE ANTONIO R BARCELO
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City | TOA ALTA
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State | PR
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Zip | 00953
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Country | UM
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Telephone | 787-230-7190
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Fax | 787-230-7190
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Provider Business Mailing Address
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Address Line | PO BOX 1649
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City | CANOVANAS
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State | PR
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Zip | 00729
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Country | UM
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Telephone | 787-230-7190
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Fax | 787-230-7190
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Authorized Official
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Title or Position | DIRECTORA
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Name | MISS ARACELIS RIVERA MERCADO
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Credential | TECNOLOGO MEDICO
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Telephone | 787-230-7190
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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 | 706
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License Number State | PR
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