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General NPI Number Information
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NPI Number | 1972063618
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Entity Type | Organization
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Legal Business Name | LABORATORIO CLINICO EBENEZER LLC
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Dates
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Enumeration Date | 03/20/2019
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Last Update Date | 03/20/2019
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Provider Practice Location Address
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Address Line | PR 8860 KM 1.2 PLAZA MATIENZO BO CUEVAS
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City | TRUJILLO ALTO
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State | PR
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Zip | 00976
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Country | US
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Telephone | 787-233-1313
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Fax |
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Provider Business Mailing Address
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Address Line | 2C25 AVE C
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City | CAROLINA
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State | PR
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Zip | 00987-7481
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Country | US
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Telephone | 787-220-1558
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. ENILDA VELAZQUEZ
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Credential | PB MT, MLS (ASCP)
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Telephone | 787-233-1313
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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 |
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License Number State |
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