=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740724517
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LABORATORIO CLINICO HATO INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/13/2016
-----------------------------------------------------
Last Update Date | 02/16/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | CARR 183 KM 7.7 BO HATO
-----------------------------------------------------
City | SAN LORENZO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00754
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-715-4488
-----------------------------------------------------
Fax | 787-715-4488
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | HC-03 BOX 12216
-----------------------------------------------------
City | CAROLINA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00987
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-715-4488
-----------------------------------------------------
Fax | 787-715-4488
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | TECNOLOGA MEDICO
-----------------------------------------------------
Name | MS. JESSICA NIEVES MELENDEZ
-----------------------------------------------------
Credential | BS
-----------------------------------------------------
Telephone | 787-715-4488
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number | 1349
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------