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General NPI Number Information
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NPI Number | 1568473171
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Entity Type | Organization
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Legal Business Name | MARIA TERESA NIEVES RODRIGUEZ
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Dates
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Enumeration Date | 08/10/2006
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Last Update Date | 06/30/2008
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Provider Practice Location Address
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Address Line | 609 AVE TITO CASTRO ST 102 PMB 353
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City | PONCE
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State | PR
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Zip | 00716-0200
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Country | US
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Telephone | 787-837-6420
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Fax | 787-260-0570
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Provider Business Mailing Address
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Address Line | CALLE LA CRUZ #3 SUITE 101
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City | JUANA DIAZ
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State | PR
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Zip | 00795
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Country | US
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Telephone | 787-837-6420
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Fax | 787-260-0570
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Authorized Official
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Title or Position | MEDICAL TECHNOLOGIST OWNER
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Name | MRS. MARIA TERESA NIEVES
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Credential | BS
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Telephone | 787-837-6420
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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 | 40D1003673
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 1063
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License Number State | PR
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