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General NPI Number Information
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NPI Number | 1740396050
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Entity Type | Organization
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Legal Business Name | SAN JUAN MEDICAL LABORATORY
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Dates
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Enumeration Date | 08/21/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 150 AVE DE DIEGO EDIFICIO SAN JUAN HEALTH CENTRE
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City | SAN JUAN
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State | PR
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Zip | 00907-2300
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Country | US
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Telephone | 787-722-5636
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Fax | 787-722-5637
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Provider Business Mailing Address
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Address Line | M3 CALLE CLAVEL PARQUES DE SANTA MARIA
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City | SAN JUAN
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State | PR
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Zip | 00927-6738
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Country | US
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Telephone | 787-722-5636
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. PEDRO JAIME BEAUCHAMP II
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Credential | M.D.
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Telephone | 787-722-5636
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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 | 710
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License Number State | PR
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