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General NPI Number Information
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NPI Number | 1760448849
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Entity Type | Organization
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Legal Business Name | LABORATORIO CLINICO BRUMBAUGH INC
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Dates
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Enumeration Date | 04/26/2006
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Last Update Date | 01/15/2020
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Provider Practice Location Address
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Address Line | STREET PINERO #80
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City | SAN JUAN
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State | PR
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Zip | 00925
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Country | US
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Telephone | 787-763-5015
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Fax | 787-766-3251
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Provider Business Mailing Address
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Address Line | STREET # 1 C-1 SAN IGNACIO PARK
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City | SAN JUAN
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State | PR
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Zip | 00921
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Country | US
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Telephone | 787-763-5015
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Fax | 787-766-3251
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. MARIA ISABEL NIDO
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Credential | M.T.
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Telephone | 787-763-5015
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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 | 367
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License Number State | PR
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