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General NPI Number Information
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NPI Number | 1619151487
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Entity Type | Organization
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Legal Business Name | LABORATORIO CLINICO OCEAN BLUE, INC.
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Dates
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Enumeration Date | 12/28/2007
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Last Update Date | 09/08/2023
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Provider Practice Location Address
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Address Line | BO. MEDIANIA ALTA CARR 187 KM. 22.7
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City | LOIZA
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State | PR
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Zip | 00772
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Country | US
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Telephone | 787-876-1694
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Fax |
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Provider Business Mailing Address
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Address Line | URB GRAND PALM II 242 CALLE ALMENDRO
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City | VEGA ALTA
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State | PR
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Zip | 00692-0000
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Country | US
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Telephone | 787-410-9719
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANGEL URIEL PAGAN OQUENDO
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Credential | MT (ASCP)
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Telephone | 787-410-9719
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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 | 1146
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License Number State | PR
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