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General NPI Number Information
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NPI Number | 1194797209
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Entity Type | Organization
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Legal Business Name | LABORATORIO CLINICO MODERNO INC.
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Dates
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Enumeration Date | 02/02/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | CARRETERA #3 KM 86.0 BO. CANDELERO ARRIBA
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City | HUMACAO
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State | PR
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Zip | 00791
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Country | US
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Telephone | 787-850-4900
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Fax | 787-850-4900
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Provider Business Mailing Address
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Address Line | PO BOX 890 PMB 416
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City | HUMACAO
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State | PR
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Zip | 00792-0890
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Country | US
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Telephone | 787-850-4900
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Fax | 787-850-4900
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Authorized Official
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Title or Position | LABORATORY DIRECTOR
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Name | MRS. SANDRA M. GARCIA
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Credential | M.T.
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Telephone | 787-850-4900
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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 | 782
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License Number State | PR
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