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General NPI Number Information
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NPI Number | 1790848554
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Entity Type | Organization
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Legal Business Name | LAB. CLINICO CARRAIZO
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Dates
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Enumeration Date | 12/19/2006
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Last Update Date | 06/28/2019
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Provider Practice Location Address
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Address Line | CARR 844 KM 5.6 BO. CARRAIZO
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City | SAN JUAN
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State | PR
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Zip | 00926
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Country | US
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Telephone | 787-755-5060
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Fax | 787-755-5060
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Provider Business Mailing Address
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Address Line | URB RIACHUELO RO 8 CALLE PLAZA ESTE
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City | TRUJILLO ALTO
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State | PR
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Zip | 00976
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Country | US
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Telephone | 787-755-5060
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Fax | 787-946-0363
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | NEFTALI TOLEDO
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Credential |
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Telephone | 787-755-5060
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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 | 918
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License Number State | PR
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