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General NPI Number Information
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NPI Number | 1639162977
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Entity Type | Organization
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Legal Business Name | CENTER DIAGNOSTIC LABORATORY,INC
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Dates
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Enumeration Date | 08/23/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1251 AVE AMERICO MIRANDA REPARTO METROPOLITANO
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City | SAN JUAN
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State | PR
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Zip | 00921-1619
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Country | US
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Telephone | 787-781-2016
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Fax |
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Provider Business Mailing Address
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Address Line | 1251 AVE AMERICO MIRANDA REPARTO METROPOLITANO
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City | SAN JUAN
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State | PR
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Zip | 00921-1619
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Country | US
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Telephone | 787-781-2016
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Fax |
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Authorized Official
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Title or Position | SUPERVISOR
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Name | EMILIA BERRIOS
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Credential | MT
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Telephone | 787-781-2016
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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 | 215
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License Number State | PR
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