=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689876815
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LABORATORIO CLINICO CIMA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/01/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | AVE PADRE RIVERA NUM23
-----------------------------------------------------
City | HUMACAO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00791
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-852-5544
-----------------------------------------------------
Fax | 787-852-2410
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | AVE PADRE RIVERA NUM23
-----------------------------------------------------
City | HUMACAO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00791
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-852-5544
-----------------------------------------------------
Fax | 787-852-2410
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENTE
-----------------------------------------------------
Name | JUAN M CINTRON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 787-893-5544
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number | 270
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------