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General NPI Number Information
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NPI Number | 1366750374
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Entity Type | Organization
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Legal Business Name | ODEMARIS LABORATORY INC
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Dates
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Enumeration Date | 09/24/2010
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Last Update Date | 04/19/2021
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Provider Practice Location Address
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Address Line | CARR. 110 KM. 0.3 BO CEIBA BAJA
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City | AGUADILLA
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State | PR
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Zip | 00605
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Country | US
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Telephone | 787-891-2154
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1789
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City | AGUADILLA
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State | PR
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Zip | 00605-1789
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Country | US
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Telephone | 787-891-2154
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Fax |
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Authorized Official
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Title or Position | SECRETARY
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Name | CINTHIA PEREZ
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Credential |
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Telephone | 787-891-2154
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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 | 1220
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License Number State | PR
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