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General NPI Number Information
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NPI Number | 1417901273
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Entity Type | Organization
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Legal Business Name | LABORATORIO CLINICO Y BACTERIOLOGICO ORIENTAL,INC.
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Dates
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Enumeration Date | 05/19/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | CALLE 13 BC-1 VILLA UNIVERSITARIA
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City | HUMACAO
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State | PR
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Zip | 00791
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Country | US
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Telephone | 787-850-3158
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Fax | 787-850-3158
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Provider Business Mailing Address
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Address Line | PO BOX 10034
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City | HUMACAO
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State | PR
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Zip | 00792-1120
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Country | US
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Telephone | 787-850-6045
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Fax | 787-850-6045
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Authorized Official
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Title or Position | DIRECTOR/PRESIDENT
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Name | MRS. LISETTE SANTIAGO
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Credential | LCDA
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Telephone | 787-850-6045
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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 | 779
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License Number State | PR
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