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General NPI Number Information
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NPI Number | 1558507590
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Entity Type | Organization
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Legal Business Name | LABORATORIO CLINICO PORTA DEL SOL, P.S.C.
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Dates
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Enumeration Date | 12/22/2008
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Last Update Date | 04/01/2014
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Provider Practice Location Address
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Address Line | BO. GUAYABO CARRETERA PR-115 KM 20.5
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City | AGUADA
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State | PR
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Zip | 00602-9739
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Country | US
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Telephone | 787-252-3167
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Fax | 787-252-3167
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Provider Business Mailing Address
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Address Line | HC 60 BOX 29241-11
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City | AGUADA
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State | PR
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Zip | 00602-9233
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Country | US
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Telephone | 787-252-3167
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Fax | 787-252-3167
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Authorized Official
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Title or Position | MEDICAL TECHNOLOGIST/PRESIDENT
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Name | MR. MAX ORLANDO NIEVES-NIEVES
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Credential | M.T.
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Telephone | 787-252-3167
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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 | 1190
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License Number State | PR
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