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General NPI Number Information
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NPI Number | 1356351621
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Entity Type | Organization
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Legal Business Name | LABORATORIO CLINICO COLON, INC
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Dates
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Enumeration Date | 08/09/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 272 CALLE MARINA
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City | AGUADA
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State | PR
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Zip | 00602-2956
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Country | US
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Telephone | 787-868-5620
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Fax | 787-868-5620
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Provider Business Mailing Address
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Address Line | 272 CALLE MARINA PO BOX 254
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City | AGUADA
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State | PR
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Zip | 00602-2956
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Country | US
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Telephone | 787-868-5620
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Fax |
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Authorized Official
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Title or Position | MEDICAL TECHNOLOGIST
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Name | MRS. DEIXTER MARIE COLON
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Credential | M.T.
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Telephone | 787-868-5620
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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 | 490
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License Number State | PR
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