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General NPI Number Information
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NPI Number | 1275959884
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Entity Type | Organization
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Legal Business Name | PUERTO RICO CITYLABS LLC
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Dates
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Enumeration Date | 03/07/2014
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Last Update Date | 03/07/2014
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Provider Practice Location Address
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Address Line | 101 AVE SAN PATRICIO MARAMAR PLAZA, SUITE G2
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City | GUAYNABO
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State | PR
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Zip | 00968-2645
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Country | US
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Telephone | 787-707-8888
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3865
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City | GUAYNABO
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State | PR
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Zip | 00970-3865
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Country | US
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Telephone | 787-707-8888
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. RADAMES MATOS
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Credential |
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Telephone | 787-707-8888
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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 | 12-098
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License Number State | PR
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