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General NPI Number Information
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NPI Number | 1528174745
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Entity Type | Organization
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Legal Business Name | LABORATORIO CLINICO BRISTOL ANGELL INC
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Dates
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Enumeration Date | 08/21/2006
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Last Update Date | 04/10/2013
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Provider Practice Location Address
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Address Line | NUM 22 OESTE AVE BALDORIOTY
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City | GUAYAMA
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State | PR
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Zip | 00784
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Country | US
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Telephone | 787-864-0630
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Fax | 787-864-8356
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Provider Business Mailing Address
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Address Line | 22 CALLE BALDORIOTY W
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City | GUAYAMA
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State | PR
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Zip | 00784-5341
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Country | US
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Telephone | 787-864-0630
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Fax | 787-864-8356
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Authorized Official
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Title or Position | GERENTE
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Name | MISS LIZTH MARIE BRISTOL ANGELI
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Credential | LIC
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Telephone | 787-864-0630
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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 | 115
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License Number State | PR
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