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General NPI Number Information
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NPI Number | 1508040718
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Entity Type | Organization
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Legal Business Name | LABORATORIO CLINICO PENUELAS
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Dates
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Enumeration Date | 12/24/2007
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Last Update Date | 12/24/2007
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Provider Practice Location Address
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Address Line | 315 CALLE MUNOZ RIVERA
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City | PENUELAS
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State | PR
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Zip | 00624-2009
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Country | US
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Telephone | 787-836-1660
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Fax | 787-836-1660
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Provider Business Mailing Address
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Address Line | 315 CALLE MUNOZ RIVERA
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City | PENUELAS
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State | PR
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Zip | 00624-2009
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Country | US
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Telephone | 787-836-1660
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Fax | 787-836-1660
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Authorized Official
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Title or Position | OWNER
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Name | RUTH E CALIZ-LOPEZ
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Credential | MT ASCP
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Telephone | 787-836-1660
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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 | PR
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