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General NPI Number Information
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NPI Number | 1952359739
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Entity Type | Organization
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Legal Business Name | BORINQUEN LABORATORY SERVICES
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Dates
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Enumeration Date | 05/04/2006
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Last Update Date | 09/20/2016
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Provider Practice Location Address
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Address Line | 76 CALLE BOLIVIA SUITE 102
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City | SAN JUAN
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State | PR
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Zip | 00917-2121
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Country | US
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Telephone | 787-753-6082
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Fax | 787-764-1909
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Provider Business Mailing Address
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Address Line | PO BOX 14334
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City | SAN JUAN
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State | PR
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Zip | 00916-4334
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Country | US
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Telephone | 787-753-6082
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Fax | 787-764-1909
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Authorized Official
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Title or Position | OWNER
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Name | MRS. LINA I GARCIA
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Credential | M T ASCP
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Telephone | 787-753-6082
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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 | 588
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License Number State | PR
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