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General NPI Number Information
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NPI Number | 1417138991
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Entity Type | Organization
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Legal Business Name | LABORATORIO CLINICO SANTIAGO IRIZARRY INC
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Dates
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Enumeration Date | 11/26/2007
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Last Update Date | 09/13/2010
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Provider Practice Location Address
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Address Line | RUDOLFO GONZALEZ #38 RUDOLFO GONZALEZ #38INT.
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City | ADJUNTAS
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State | PR
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Zip | 00601-2333
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Country | US
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Telephone | 787-829-2541
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Fax | 787-829-2541
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Provider Business Mailing Address
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Address Line | RUDOLFO GONZALEZ # 38
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City | ADJUNTAS
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State | PR
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Zip | 00601-2333
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Country | US
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Telephone | 787-829-2541
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Fax | 787-829-2541
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Authorized Official
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Title or Position | PRESIDENT/DIRECTOR
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Name | MR. FERDINAND SANTIAGO
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Credential | MT(ASCP),MS
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Telephone | 787-829-2541
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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 | 780
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License Number State | PR
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