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General NPI Number Information
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NPI Number | 1346451895
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Entity Type | Organization
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Legal Business Name | PROGRAMA SIDA DE SAN JUAN-LAB
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Dates
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Enumeration Date | 05/25/2007
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Last Update Date | 03/11/2022
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Provider Practice Location Address
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Address Line | 1306 AVE FERNANDEZ JUNCOS
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City | SAN JUAN
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State | PR
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Zip | 00909-2521
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Country | US
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Telephone | 787-723-2424
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Fax |
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Provider Business Mailing Address
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Address Line | 1306 AVE FERNANDEZ JUNCOS
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City | SAN JUAN
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State | PR
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Zip | 00909-2521
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Country | US
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Telephone | 787-723-2424
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR/CEO
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Name | DR. LUIS V CLAS
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Credential | MD
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Telephone | 787-480-3838
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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 | CLIA 40D0919476
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License Number State | PR
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