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General NPI Number Information
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NPI Number | 1831289651
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Entity Type | Organization
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Legal Business Name | LAB CLINICO Y REFERENCIA ESCUELA MEDICINA PONCE
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Dates
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Enumeration Date | 10/13/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | MOTERREY ST # 280
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City | PONCE
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State | PR
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Zip | 00732
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Country | US
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Telephone | 787-840-2580
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 7004
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City | PONCE
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State | PR
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Zip | 00732-7004
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Country | US
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Telephone | 787-840-2580
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Fax | 787-843-6949
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Authorized Official
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Title or Position | REPRESENTATIVE BOARD OF TRUSTEES
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Name | JORGE L SANCHEZ
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Credential | MD
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Telephone | 787-844-3710
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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 | 1058
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License Number State | PR
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