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General NPI Number Information
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NPI Number | 1861827701
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Entity Type | Organization
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Legal Business Name | ALCIDES OQUENDO SOLIS
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Dates
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Enumeration Date | 09/11/2013
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Last Update Date | 09/11/2013
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Provider Practice Location Address
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Address Line | 350 AVE FONT MARTELO SUITE 2
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City | HUMACAO
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State | PR
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Zip | 00791-3266
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Country | US
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Telephone | 787-612-0155
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Fax |
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Provider Business Mailing Address
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Address Line | 350 AVENIDA FONT MARTELO SUITE 2
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City | HUMACAO
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State | PR
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Zip | 00791
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Country | UM
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Telephone | 787-612-0155
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ALCIDES OQUENDO SR.
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Credential |
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Telephone | 787-612-0155
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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 | 945
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License Number State | PR
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