=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902979990
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MAGALY FLORES VERDEJO
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/16/2006
-----------------------------------------------------
Last Update Date | 12/27/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12 MARGINAL 65 INFANTERIA URB SAN AGUSTIN
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00923
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-759-6804
-----------------------------------------------------
Fax | 787-759-6804
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 29483
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00929-0483
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-759-6804
-----------------------------------------------------
Fax | 787-759-6804
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | MS. MAGALY FLORES - VERDEJO
-----------------------------------------------------
Credential | BS,MT(ASCP)
-----------------------------------------------------
Telephone | 787-759-6804
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number | 635
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------