=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649238650
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LABORATORIO CLINICO ALEJANDRINO, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/02/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 310 LOMAS VERDES AVE. SUITE 203
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00927-6638
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-764-4593
-----------------------------------------------------
Fax | 787-276-0677
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 310 AVE LOMAS VERDES SUITE 203
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00927-6638
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-764-4593
-----------------------------------------------------
Fax | 787-276-0677
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL CONSULTANT
-----------------------------------------------------
Name | DR. ARNALDO R QUINONES
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 787-764-4593
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number | 882
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------