=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568552610
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LABORATORIO CLINICO CHEGAR INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/12/2006
-----------------------------------------------------
Last Update Date | 04/24/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 71 CALLE AUTONOMIA
-----------------------------------------------------
City | CANOVANAS
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00729
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-256-6570
-----------------------------------------------------
Fax | 787-876-4770
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 71 CALLE AUTONOMIA
-----------------------------------------------------
City | CANOVANAS
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00729-3288
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-256-6570
-----------------------------------------------------
Fax | 787-876-4770
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTORA
-----------------------------------------------------
Name | MRS. CARMEN J CEPEDA
-----------------------------------------------------
Credential | B.S.,MT.,AS.CP.
-----------------------------------------------------
Telephone | 787-809-4697
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number | 252
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------