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General NPI Number Information
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NPI Number | 1508956319
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Entity Type | Organization
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Legal Business Name | WAXALI INC
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Dates
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Enumeration Date | 10/13/2006
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Last Update Date | 04/11/2014
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Provider Practice Location Address
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Address Line | # 43 CALLE IGNACIO MORALES ACOSTA
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City | NARANJITO
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State | PR
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Zip | 00719-8771
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Country | US
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Telephone | 787-869-9585
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Fax | 787-869-0907
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Provider Business Mailing Address
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Address Line | HC 72 BOX 3954
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City | NARANJITO
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State | PR
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Zip | 00719-8771
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Country | US
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Telephone | 787-869-9585
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Fax | 787-869-0907
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Authorized Official
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Title or Position | PRESIDENT OWNER
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Name | MR. JOSE L COLLAZO ROSADO
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Credential | MT
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Telephone | 787-869-9585
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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 | 594
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License Number State | PR
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