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General NPI Number Information
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NPI Number | 1326219650
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Entity Type | Organization
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Legal Business Name | LA VIDA MEDICAL GROUP HATILLO CORP
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Dates
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Enumeration Date | 03/14/2008
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Last Update Date | 05/16/2008
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Provider Practice Location Address
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Address Line | 549 CALLE DEL MAR SUITE 302
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City | HATILLO
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State | PR
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Zip | 00659-2869
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Country | US
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Telephone | 787-880-2363
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Fax | 787-881-4312
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Provider Business Mailing Address
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Address Line | 549 CALLE DEL MAR SUITE 302
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City | HATILLO
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State | PR
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Zip | 00659-2869
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Country | US
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Telephone | 787-880-2363
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Fax | 787-881-4312
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | MRS. DIANA I MATOS
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Credential |
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Telephone | 787-880-2363
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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 |
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License Number State |
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