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General NPI Number Information
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NPI Number | 1538348875
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Entity Type | Organization
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Legal Business Name | LABORATORIO CLINICO PLAZA ENCANTADA INC
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Dates
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Enumeration Date | 11/02/2007
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Last Update Date | 03/14/2008
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Provider Practice Location Address
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Address Line | CARR 181 C4 AVE ENCANTADA
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City | TRUJILLO ALTO
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State | PR
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Zip | 00976
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Country | US
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Telephone | 787-748-3010
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Fax | 787-748-3011
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Provider Business Mailing Address
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Address Line | CARR 181 C4 AVE ENCANTADA
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City | TRUJILLO ALTO
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State | PR
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Zip | 00976
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Country | US
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Telephone | 787-748-3010
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Fax | 787-748-3011
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Authorized Official
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Title or Position | OWNER
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Name | MR. MIGUEL A RODRIGUEZ
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Credential | LCDO
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Telephone | 787-748-3010
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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 | 1083
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License Number State | PR
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