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General NPI Number Information
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NPI Number | 1295844553
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Entity Type | Organization
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Legal Business Name | LABORATORIO DEL SUENO INC
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 12/05/2012
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Provider Practice Location Address
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Address Line | 100 PASEO SAN PABLO EDIFICIO ARTURO CADILLA SUITE 206
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City | BAYAMON
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State | PR
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Zip | 00961-7022
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Country | US
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Telephone | 787-786-8196
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Fax |
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Provider Business Mailing Address
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Address Line | 100 PASEO SAN PABLO EDIFICIO ARTURO CADILLA SUITE 206
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City | BAYAMON
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State | PR
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Zip | 00961-7022
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Country | US
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Telephone | 787-786-8196
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CRISPULO M RIVERA
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Credential | MD
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Telephone | 787-786-8196
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 3000
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License Number State | PR
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