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General NPI Number Information
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NPI Number | 1760789556
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Entity Type | Organization
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Legal Business Name | EASTERN VALLEY CLINICAL LABORATORIES, INC.
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Dates
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Enumeration Date | 02/15/2011
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Last Update Date | 05/25/2011
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Provider Practice Location Address
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Address Line | CARR 976 KM 2.7 BO FLORENCIO
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City | FAJARDO
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State | PR
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Zip | 00738
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Country | US
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Telephone | 787-655-7755
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Fax | 787-655-7755
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Provider Business Mailing Address
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Address Line | 10 CALLE ICACOS THE VILLAGE AT THE HILL
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City | CEIBA
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State | PR
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Zip | 00735-3902
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Country | US
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Telephone | 787-398-4758
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Fax | 787-655-7755
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Authorized Official
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Title or Position | MEDICAL TECHNOLOGIST
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Name | ELISA B PACHECO
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Credential | MS, MT (ASCP)
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Telephone | 787-655-7755
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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 | 1233
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License Number State | PR
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