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General NPI Number Information
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NPI Number | 1992112080
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Entity Type | Organization
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Legal Business Name | LABORATORIO CLINICO DEL SURESTE,INC
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Dates
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Enumeration Date | 07/21/2014
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Last Update Date | 07/21/2014
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Provider Practice Location Address
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Address Line | 21 CALLE ANTONIO R BARCELO
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City | MAUNABO
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State | PR
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Zip | 00707-2141
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Country | US
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Telephone | 787-861-0100
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Fax | 787-861-3156
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Provider Business Mailing Address
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Address Line | PO BOX 1340
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City | YABUCOA
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State | PR
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Zip | 00767-1340
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Country | US
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Telephone | 787-861-0100
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Fax | 787-861-3156
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Authorized Official
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Title or Position | GENERAL SUPERVISOR
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Name | MR. YANIRE CASTRO
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Credential |
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Telephone | 787-861-0100
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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 | 597
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License Number State | PR
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