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General NPI Number Information
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NPI Number | 1336378777
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Entity Type | Organization
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Legal Business Name | JOSE A MAIZ DEDOS
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Dates
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Enumeration Date | 07/07/2009
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Last Update Date | 02/17/2010
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Provider Practice Location Address
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Address Line | CARR. # 1 KM. 114.5 BO CINTRONA SECTOR SINGAPUR
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City | JUANA DIAZ
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State | PR
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Zip | 00795-9614
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Country | US
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Telephone | 787-837-7600
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Fax | 787-837-7600
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Provider Business Mailing Address
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Address Line | HC 02 BOX 10001
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City | JUANA DIAZ
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State | PR
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Zip | 00795-9614
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Country | US
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Telephone | 787-837-7600
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Fax | 787-837-7600
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Authorized Official
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Title or Position | OWNER
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Name | MR. JOSE A MAIZ DEDOS
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Credential | M.T.
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Telephone | 787-837-7600
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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 | 1193
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License Number State | PR
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