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General NPI Number Information
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NPI Number | 1972715779
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Entity Type | Organization
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Legal Business Name | AUSBERTO GONZALEZ
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 07/08/2014
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Provider Practice Location Address
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Address Line | 117 ST. KM 5.5 LAJAS ARRIBA
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City | LAJAS
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State | PR
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Zip | 00667
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Country | US
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Telephone | 787-899-3045
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Fax | 787-899-3045
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Provider Business Mailing Address
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Address Line | PO BOX 599
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City | YAUCO
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State | PR
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Zip | 00698-0599
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Country | US
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Telephone | 787-899-3045
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Fax | 787-899-3045
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Authorized Official
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Title or Position | OWNER
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Name | MR. AUSBERTO GONZALEZ
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Credential | M.T.
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Telephone | 787-899-3045
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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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