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General NPI Number Information
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NPI Number | 1538201470
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Entity Type | Organization
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Legal Business Name | LABORATORIO BIOMEDICO DE PUERTO RICO
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 06/09/2016
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Provider Practice Location Address
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Address Line | 380 DOMENECH
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City | SAN JUAN
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State | PR
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Zip | 00918-3716
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Country | US
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Telephone | 787-751-0601
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Fax | 787-751-0601
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Provider Business Mailing Address
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Address Line | 380 AVE DOMENCH
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City | SAN JUAN
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State | PR
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Zip | 00918-3716
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Country | US
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Telephone | 787-751-0601
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. ANA M CORDERO
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Credential |
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Telephone | 787-751-0601
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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 | 0321
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License Number State | PR
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