=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962727610
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CLINICAL LABORATORY SOLUTION, PSC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/06/2010
-----------------------------------------------------
Last Update Date | 04/06/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | CARR PR 2 KM30.4 PARCELAS CARMEN 7-A BARRIO ESPINOSA
-----------------------------------------------------
City | VEGA ALTA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00692
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-528-7083
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | CALLE ALONDRA 339 URB.LOS MONTE
-----------------------------------------------------
City | DORADO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00646
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-398-9433
-----------------------------------------------------
Fax | 787-883-8520
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SUPERVISOR
-----------------------------------------------------
Name | MRS. YARITZI APONTE
-----------------------------------------------------
Credential | M.T.
-----------------------------------------------------
Telephone | 787-528-1086
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------