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General NPI Number Information
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NPI Number | 1306922737
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Entity Type | Organization
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Legal Business Name | FREMANOR, INC.
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Dates
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Enumeration Date | 10/27/2006
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Last Update Date | 11/18/2011
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Provider Practice Location Address
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Address Line | CENTRO GRAN CARIBE MALL SECOND LEVEL OFFICE 205
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City | VEGA ALTA
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State | PR
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Zip | 00692
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Country | US
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Telephone | 787-270-1717
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3031
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City | VEGA ALTA
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State | PR
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Zip | 00692-3031
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Country | US
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Telephone | 787-270-1717
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Fax | 787-270-1717
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Authorized Official
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Title or Position | ADMINISTRATOR/M.T.
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Name | MRS. NORMA H COLLAZO
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Credential | M.T.
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Telephone | 787-270-1717
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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 | 1038
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License Number State | PR
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