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General NPI Number Information
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NPI Number | 1659365153
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Entity Type | Organization
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Legal Business Name | LABORATORIO CLINICO VILLA BLANCA,LLC
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Dates
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Enumeration Date | 09/12/2005
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Last Update Date | 05/11/2022
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Provider Practice Location Address
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Address Line | 58 AQUAMARINA STREET VILLA BLANCA
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City | CAGUAS
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State | PR
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Zip | 00726
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Country | US
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Telephone | 787-746-1686
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Fax | 787-746-1686
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Provider Business Mailing Address
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Address Line | PO BOX 6782
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City | CAGUAS
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State | PR
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Zip | 00726-6782
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Country | US
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Telephone | 787-746-1686
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Fax | 787-746-1686
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Authorized Official
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Title or Position | MEDICAL TECHNOLOGIST
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Name | MRS. LUZ I RIOS
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Credential | MT ASCP
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Telephone | 787-746-1686
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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 | 40D0863294
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License Number State | PR
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