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General NPI Number Information
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NPI Number | 1881661189
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Entity Type | Organization
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Legal Business Name | LAB CLINICO LOMAS VERDES INC
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Dates
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Enumeration Date | 03/06/2006
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Last Update Date | 11/27/2012
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Provider Practice Location Address
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Address Line | 1353 RD 19 PMB 423
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City | GUAYNABO
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State | PR
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Zip | 00966-2700
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Country | US
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Telephone | 787-787-7417
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Fax | 787-780-9220
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Provider Business Mailing Address
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Address Line | Z39 AVE LAUREL LOMAS VERDES
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City | BAYAMON
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State | PR
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Zip | 00956-3244
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Country | US
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Telephone | 787-787-7417
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Fax | 787-780-9220
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Authorized Official
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Title or Position | PRESIDENTA
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Name | MR. MILAGROS IVELISSE PEREZ
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Credential |
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Telephone | 787-413-7090
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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 | 276
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License Number State | PR
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