=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821052523
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LABORATORIO CLINICO RISAN
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/12/2006
-----------------------------------------------------
Last Update Date | 10/04/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | URB COUNTRY CLUB GP1 AVE. SANCHEZ VILELLA
-----------------------------------------------------
City | CAROLINA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00982
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-762-9466
-----------------------------------------------------
Fax | 787-762-9467
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | URB VILLAS REALES CALLE VERSALLES 362
-----------------------------------------------------
City | GUAYNABO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00969
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-934-9275
-----------------------------------------------------
Fax | 787-762-9467
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MAIRINE BIGIO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 787-762-9466
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number | 349
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------