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General NPI Number Information
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NPI Number | 1578619292
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Entity Type | Organization
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Legal Business Name | LABORATORIO CLINICO JARDINES
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Dates
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Enumeration Date | 01/26/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | BE # 5 AVE GALICIA JDNES COUNTRY CLUB
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City | CAROLINA
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State | PR
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Zip | 00983
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Country | US
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Telephone | 787-752-4010
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Fax | 787-768-5818
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Provider Business Mailing Address
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Address Line | PO BOX 3278
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City | CAROLINA
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State | PR
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Zip | 00984-3278
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Country | US
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Telephone | 787-752-4010
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Fax | 787-768-5818
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Authorized Official
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Title or Position | LABORATORY DIRECTOR
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Name | SUSANA BERRIOS
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Credential | MEDICAL TECHNOLOGIST
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Telephone | 787-752-4010
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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 | 685
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License Number State | PR
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