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General NPI Number Information
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NPI Number | 1871879197
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Entity Type | Organization
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Legal Business Name | LABORATORIO CLINICON COLON #3
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Dates
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Enumeration Date | 11/01/2011
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Last Update Date | 11/01/2011
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Provider Practice Location Address
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Address Line | 358 AVE FONT MARTELO ROSADO MEDICAL BUILDING
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City | HUMACAO
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State | PR
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Zip | 00791-3222
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Country | US
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Telephone | 787-285-1680
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 85
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City | YABUCOA
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State | PR
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Zip | 00767-0085
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Country | US
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Telephone | 787-285-1680
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Fax |
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Authorized Official
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Title or Position | LABORATORY SUPERVISOR
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Name | MRS. YANIRE CASTRO
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Credential | MEDICAL TECNOLOGIST
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Telephone | 787-285-1680
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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 | 1032
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License Number State | PR
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