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General NPI Number Information
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NPI Number | 1932130515
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Entity Type | Organization
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Legal Business Name | LABORATORIO CLINICO MEDINA INC.
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Dates
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Enumeration Date | 07/05/2006
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Last Update Date | 07/22/2008
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Provider Practice Location Address
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Address Line | CALLE JUAN R. GARZOT #43
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City | NAGUABO
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State | PR
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Zip | 00718
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Country | US
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Telephone | 787-874-2802
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Fax | 787-874-0075
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Provider Business Mailing Address
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Address Line | PO BOX 1211
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City | NAGUABO
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State | PR
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Zip | 00718-1211
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Country | US
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Telephone | 787-874-2802
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Fax | 787-874-0075
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. RUTH E MEDINA
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Credential | LIC 1671
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Telephone | 787-874-2802
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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 | 647
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License Number State | PR
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