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General NPI Number Information
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NPI Number | 1184747768
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Entity Type | Organization
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Legal Business Name | ENIDIA VELEZ LOPEZ
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Dates
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Enumeration Date | 04/09/2007
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Last Update Date | 06/07/2010
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Provider Practice Location Address
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Address Line | 39 CALLE LUIS MUNOZ RIVERA
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City | SABANA GRANDE
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State | PR
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Zip | 00637-1812
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Country | US
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Telephone | 787-873-4260
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 628
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City | SABANA GRANDE
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State | PR
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Zip | 00637-0628
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Country | US
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Telephone | 787-873-4260
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. ELSIE E. VELEZ LOPEZ
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Credential |
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Telephone | 787-649-7895
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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 | 553
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License Number State | PR
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