=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598855629
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LABORATORIO CLINICO CHEGAR INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/12/2006
-----------------------------------------------------
Last Update Date | 01/09/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | AVE GARCIA DE LA NOCEDA B 27 VILLAS DE RIO GRANDE
-----------------------------------------------------
City | RIO GRANDE
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00745
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-809-4697
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 497
-----------------------------------------------------
City | RIO GRANDE
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00745-0497
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-887-3394
-----------------------------------------------------
Fax | 787-888-4540
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTORA
-----------------------------------------------------
Name | MISS 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 | 460
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------