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General NPI Number Information
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NPI Number | 1356596068
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Entity Type | Organization
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Legal Business Name | MARIA DE LOURDES VENTURA DE JESUS LABORATORIO CLINICO VILLA CAPRI
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Dates
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Enumeration Date | 11/21/2008
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Last Update Date | 03/01/2012
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Provider Practice Location Address
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Address Line | 603 CALLE LODI VILLA CAPRI
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City | SAN JUAN
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State | PR
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Zip | 00924-3842
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Country | US
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Telephone | 787-763-8435
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2500 PMB 48
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City | TRUJILLO ALTO
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State | PR
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Zip | 00977-2500
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Country | US
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Telephone | 787-763-8435
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. MARIA VENTURA
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Credential | M.T.
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Telephone | 787-763-8435
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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 | 117
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License Number State | PR
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