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General NPI Number Information
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NPI Number | 1821197393
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Entity Type | Organization
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Legal Business Name | LABORATORIO CLINICO POMALES
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Dates
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Enumeration Date | 09/21/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | STREET #3 KM 151.5
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City | AGUIRRE
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State | PR
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Zip | 00704
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Country | US
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Telephone | 787-853-0382
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Fax | 787-853-0482
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Provider Business Mailing Address
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Address Line | PO BOX 1078
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City | GUAYAMA
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State | PR
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Zip | 00785-1078
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Country | US
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Telephone | 787-853-0382
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Fax | 787-853-0482
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Authorized Official
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Title or Position | LAB OWNER
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Name | MR. EDRICK EDUARDO POMALES
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Credential | MT
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Telephone | 787-853-0382
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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 | 1023
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License Number State | PR
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