=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356768246
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LABORATORIO CLINICO ALFECIZA INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/28/2014
-----------------------------------------------------
Last Update Date | 07/10/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | CARR 149 ESQ. BORINQUEN #44
-----------------------------------------------------
City | VILLALBA
-----------------------------------------------------
State | PUERTO RICO
-----------------------------------------------------
Zip | 00766
-----------------------------------------------------
Country | UM
-----------------------------------------------------
Telephone | 787-847-0260
-----------------------------------------------------
Fax | 787-847-5693
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | CARR 149 ESQ. BORINQUEN #44
-----------------------------------------------------
City | VILLALBA
-----------------------------------------------------
State | PUERTO RICO
-----------------------------------------------------
Zip | 00766
-----------------------------------------------------
Country | UM
-----------------------------------------------------
Telephone | 787-847-0260
-----------------------------------------------------
Fax | 787-847-5693
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | MRS. DAISY ZAYAS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 787-847-0260
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number | 1574
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------