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General NPI Number Information
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NPI Number | 1417963299
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Entity Type | Organization
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Legal Business Name | LABORATORIO CLINICO PARQUE ESCORIAL
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Dates
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Enumeration Date | 07/31/2006
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Last Update Date | 01/20/2017
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Provider Practice Location Address
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Address Line | 5829 AVE 65 INFANTERIA PLAZA ESCORIAL STE 109
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City | CAROLINA
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State | PR
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Zip | 00987-5007
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Country | US
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Telephone | 787-257-8861
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Fax |
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Provider Business Mailing Address
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Address Line | 5829 AVE 65 INFANTERIA PLAZA ESCORIAL STE 109
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City | CAROLINA
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State | PR
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Zip | 00987-5007
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Country | US
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Telephone | 787-257-8861
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. MIGUEL A RODRIGUEZ
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Credential | LCDO.
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Telephone | 787-257-8861
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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 | 1079
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License Number State | PR
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