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General NPI Number Information
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NPI Number | 1811172828
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Entity Type | Organization
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Legal Business Name | LABORATORIO CLINICO EL CONQUISTADOR I INC
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Dates
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Enumeration Date | 01/09/2008
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Last Update Date | 03/12/2008
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Provider Practice Location Address
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Address Line | CENTRO COMERCIAL EL CONQUISTADOR PLAZA COURT CARR. 190, KM 0.7, MARGINAL BALDORIOTY DE CASTRO
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City | CAROLINA
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State | PR
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Zip | 00985
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Country | UM
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Telephone | 787-752-2228
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Fax | 787-752-2715
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Provider Business Mailing Address
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Address Line | CALLE CASTELLON 734 UBANIZACION VISTAMAR
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City | CAROLINA
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State | PUERTO RICO
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Zip | 00983
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Country | UM
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Telephone | 787-646-4608
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Fax | 787-888-4774
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. WANDA DAMARIS GONZALEZ
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Credential |
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Telephone | 787-646-4608
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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 | 1145
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License Number State | PR
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