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General NPI Number Information
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NPI Number | 1336223189
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Entity Type | Organization
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Legal Business Name | VINCENTE CALDERON RODRIGUEZ
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 10/03/2018
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Provider Practice Location Address
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Address Line | JR1 CALLE LIZZIE GRAHAM LEVITTOWN
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City | TOA BAJA
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State | PR
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Zip | 00949-3637
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Country | US
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Telephone | 787-261-1169
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6085
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City | SAN JUAN
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State | PR
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Zip | 00914-6085
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Country | US
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Telephone | 787-261-1169
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. ELIZABETH ALICEA
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Credential | MT
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Telephone | 787-261-1169
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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 | 612
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License Number State | PR
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