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General NPI Number Information
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NPI Number | 1306088158
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Entity Type | Organization
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Legal Business Name | LABORATORIO CLINICO EXPRESO JVG
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Dates
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Enumeration Date | 03/25/2009
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Last Update Date | 03/25/2009
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Provider Practice Location Address
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Address Line | CARR 149 KM 9.8
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City | CIALES
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State | PR
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Zip | 00638
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Country | US
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Telephone | 787-983-7399
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Fax |
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Provider Business Mailing Address
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Address Line | CARR 149 KM 9.8 INTERSECCION CAMPAMENTO
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City | CIALES
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State | PUERTO RICO
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Zip | 00703
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Country | UM
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Telephone | 787-983-7399
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Fax |
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Authorized Official
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Title or Position | TECNOLOGIST
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Name | MS. JESSICA VILLAFANE
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Credential | LCDA
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Telephone | 787-983-7399
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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 | 1042
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License Number State | PR
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