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General NPI Number Information
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NPI Number | 1316021504
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Entity Type | Organization
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Legal Business Name | LABORATORIO CLINICO FAIR VIEW CSP
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Dates
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Enumeration Date | 10/24/2006
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Last Update Date | 06/29/2016
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Provider Practice Location Address
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Address Line | CARRETERA 845 KM 3.3 CENTRO COMERCIAL FAIRVIEW SUITE 7
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City | TRUJILLO ALTO
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State | PR
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Zip | 00976
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Country | US
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Telephone | 787-292-8789
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Fax | 787-292-8757
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Provider Business Mailing Address
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Address Line | EL SENORIAL MAIL STATION MSC 779
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City | SAN JUAN
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State | PR
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Zip | 00926-6023
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Country | US
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Telephone | 787-292-8789
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Fax | 787-292-8757
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Authorized Official
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Title or Position | OWNER AND ADMINISTRATOR
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Name | MR. LUIS ORTEGA VERGE
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Credential |
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Telephone | 787-292-8789
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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 | 1051
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License Number State | PR
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