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General NPI Number Information
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NPI Number | 1710176177
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Entity Type | Organization
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Legal Business Name | LABORATORIO CLINICO SAN ANTONIO
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Dates
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Enumeration Date | 10/22/2007
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Last Update Date | 02/08/2016
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Provider Practice Location Address
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Address Line | 1488 AVE EMERITO ESTRADA RIVERA
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City | SAN SEBASTIAN
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State | PR
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Zip | 00685-3023
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Country | US
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Telephone | 787-896-1076
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Fax | 787-896-1076
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Provider Business Mailing Address
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Address Line | PO BOX 2003
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City | SAN SEBASTIAN
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State | PR
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Zip | 00685-8003
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Country | US
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Telephone | 787-896-1076
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Fax | 787-896-1076
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Authorized Official
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Title or Position | OWNER
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Name | MARIBEL GONZALEZ
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Credential | M.T.
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Telephone | 787-896-1076
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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 | 193
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License Number State | PR
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