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General NPI Number Information
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NPI Number | 1760756811
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Entity Type | Organization
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Legal Business Name | LJ HEALTH GROUP INC
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Dates
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Enumeration Date | 03/06/2012
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Last Update Date | 03/06/2012
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Provider Practice Location Address
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Address Line | #131 MUNOZ RIVERA
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City | HATILLO
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State | PR
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Zip | 00659
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Country | US
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Telephone | 787-898-2106
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 832
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City | MANATI
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State | PR
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Zip | 00674
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Country | US
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Telephone | 787-501-8891
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. JANNETTE CANDELARIA
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Credential |
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Telephone | 787-501-8891
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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 | 513
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License Number State | PR
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