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General NPI Number Information
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NPI Number | 1932186855
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Entity Type | Organization
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Legal Business Name | NILSA IVETTE SANCHEZ SHUMATE/LABORATORIO CLINICO MODELO
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Dates
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Enumeration Date | 12/30/2005
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Last Update Date | 09/13/2023
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Provider Practice Location Address
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Address Line | 170 AVE BARBOSA
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City | CATANO
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State | PR
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Zip | 00962
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Country | US
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Telephone | 787-788-1428
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Fax | 787-788-2409
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Provider Business Mailing Address
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Address Line | PO BOX 598
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City | CATANO
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State | PR
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Zip | 00963-0598
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Country | US
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Telephone | 787-788-1428
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Fax | 787-788-2409
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Authorized Official
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Title or Position | OWNER
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Name | MRS. NILSA I SANCHEZ SHUMATE
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Credential | BA
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Telephone | 787-788-1428
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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 | 523
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License Number State | PR
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