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General NPI Number Information
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NPI Number | 1700077765
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Entity Type | Organization
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Legal Business Name | LABORATORIO CLINICO RURAL TRUJILLO ALTO
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Dates
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Enumeration Date | 08/06/2007
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Last Update Date | 08/06/2007
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Provider Practice Location Address
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Address Line | RD. 181 KM 8.6 BO. DOS BOCAS
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City | TRUJILLO ALTO
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State | PR
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Zip | 00977
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Country | US
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Telephone | 787-760-4500
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Fax | 787-283-2950
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Provider Business Mailing Address
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Address Line | PO BOX 1468
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City | TRUJILLO ALTO
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State | PR
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Zip | 00977-1468
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Country | US
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Telephone | 787-760-4500
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Fax | 787-283-2950
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. SONYA L. GOYTIA
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Credential | MS MT ASCP
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Telephone | 787-760-4500
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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 | 852
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License Number State | PR
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