=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326378829
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NORFREMA INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/05/2010
-----------------------------------------------------
Last Update Date | 09/03/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | CARR. 696 KM 1.4 SAN ANTONIO BO HIGUILLAR
-----------------------------------------------------
City | DORADO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00646
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-278-3030
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 3031
-----------------------------------------------------
City | VEGA ALTA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00692-3031
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. FREDDIE G MONTANEZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 787-278-3030
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number | 1202
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------