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General NPI Number Information
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NPI Number | 1891766507
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Entity Type | Organization
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Legal Business Name | MARITZA E GRAJALES SOTO
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Dates
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Enumeration Date | 01/30/2006
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Last Update Date | 07/30/2014
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Provider Practice Location Address
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Address Line | AVE ROBERTO CLEMENTE CALLE 11 BLOQUE 33 # 17 URB VILLA CAROLINA
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City | CAROLINA
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State | PR
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Zip | 00985-5436
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Country | US
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Telephone | 787-769-8349
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Fax | 787-257-8490
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Provider Business Mailing Address
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Address Line | PO BOX 3386
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City | CAROLINA
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State | PR
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Zip | 00984-3386
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Country | US
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Telephone | 787-769-8349
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Fax | 787-257-8490
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Authorized Official
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Title or Position | OWNER
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Name | MRS. MARITZA E GRAJALES SOTO
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Credential | BSMTASCP
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Telephone | 787-667-1902
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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 | 266
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License Number State | PR
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