=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932220928
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FIRST CLINICAL LAB
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/03/2007
-----------------------------------------------------
Last Update Date | 03/16/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1007 AVE MUNOZ RIVERA COND DARLINGTON L-13
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00925
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-764-5073
-----------------------------------------------------
Fax | 787-753-0276
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1007 AVE MUNOZ RIVERA COND DARLINGTON L-13
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00925-2717
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-764-5073
-----------------------------------------------------
Fax | 787-753-0276
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENTE
-----------------------------------------------------
Name | MR. LUIS MORALES SEDA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 787-764-5073
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------