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General NPI Number Information
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NPI Number | 1477640530
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Entity Type | Organization
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Legal Business Name | JUAN LOPEZ VELAQUEZ
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Dates
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Enumeration Date | 10/09/2006
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Last Update Date | 03/30/2009
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Provider Practice Location Address
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Address Line | 961 CALLE MUNOZ RIVERA
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City | PENUELAS
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State | PR
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Zip | 00624-1400
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Country | US
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Telephone | 787-836-7926
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Fax |
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Provider Business Mailing Address
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Address Line | 188 CALLE INVIERNO BRISAS DEL GUAYANES
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City | PENUELAS
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State | PR
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Zip | 00624-3012
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Country | US
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Telephone | 787-836-7926
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Fax |
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Authorized Official
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Title or Position | GENERAL SUPERVISOR
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Name | MR. JUAN LOPEZ
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Credential | MT
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Telephone | 787-836-7926
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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 | 1014
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License Number State | PR
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