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General NPI Number Information
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NPI Number | 1487051181
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Entity Type | Organization
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Legal Business Name | LABORATORIO CLINICO PRINCIPAL SAN FERNANDO, INC
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Dates
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Enumeration Date | 11/24/2014
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Last Update Date | 11/24/2014
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Provider Practice Location Address
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Address Line | CARR. #2 KM 7.56 EDIF. 171 SECTOR JUAN DOMINGO, BARRIO PUEBLO VIEJO
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City | GUAYNABO
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State | PR
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Zip | 00966
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Country | US
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Telephone | 787-919-7060
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Fax | 787-919-7061
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Provider Business Mailing Address
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Address Line | PO BOX 1528
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City | BAYAMON
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State | PR
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Zip | 00960-1528
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Country | US
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Telephone | 787-919-7060
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Fax | 787-919-7061
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | ROSEANNE M AMADO
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Credential |
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Telephone | 787-919-7060
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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 |
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License Number State |
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