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General NPI Number Information
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NPI Number | 1992901318
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Entity Type | Organization
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Legal Business Name | CLINILAB
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Dates
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Enumeration Date | 06/22/2007
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | AVE LOS ATLETICOS DE SAN GERMAN #222
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City | SAN GERMAN
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State | PR
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Zip | 00683
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Country | US
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Telephone | 787-892-0520
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Fax |
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Provider Business Mailing Address
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Address Line | P.O. BOX 268
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City | SAN GERMAN
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State | PR
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Zip | 00683-0268
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Country | US
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Telephone | 787-892-0520
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Fax |
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Authorized Official
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Title or Position | SUPERVISOR
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Name | TANIA CELESTE CHICO
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Credential | M.T.
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Telephone | 787-892-0520
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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 | 915
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License Number State | PR
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