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General NPI Number Information
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NPI Number | 1275629388
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Entity Type | Organization
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Legal Business Name | LABORATORIO TERESITA
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Dates
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Enumeration Date | 10/05/2006
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Last Update Date | 05/30/2019
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Provider Practice Location Address
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Address Line | 40 CALLE MUNOZ RIVERA
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City | VEGA ALTA
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State | PR
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Zip | 00692-6530
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Country | US
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Telephone | 787-883-1009
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Fax | 787-883-1009
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Provider Business Mailing Address
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Address Line | 40 CALLE MUNOZ RIVERA
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City | VEGA ALTA
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State | PR
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Zip | 00692-6530
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Country | US
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Telephone | 787-883-1009
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Fax | 787-883-1009
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Authorized Official
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Title or Position | DUENA
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Name | JESSICA ZAMARA GONZALEZ
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Credential |
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Telephone | 787-675-0112
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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 | 720
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License Number State | PR
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