MEDICARE: LABORATORIO CLINICO VILLA LOS SANTOS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory	585	PR

General Provider Information

NPI Number	:	1073583514
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LABORATORIO CLINICO VILLA LOS SANTOS

Provider Business Mailing Address
First Line	:	PO BOX 9091
Second Line	:	COTTO STATION
City	:	ARECIBO
State	:	PR
Zip	:	00613-9091
Country	:	US
Telephone Number	:	787-879-1609
Fax Number	:	787-880-3733

Provider Business Practice Location Address
First Line	:	V1 CALLE 16
Second Line	:	URB. VILLA LOS SANTOS
City	:	ARECIBO
State	:	PR
Zip	:	00612-3112
Country	:	US
Telephone Number	:	787-879-1609
Fax Number	:	787-880-3733

Authorized Official
Title or Position	:	DIRECTORA
Name	:	MRS. MARIA GONZALEZ
Credential	:
Telephone Number	:	787-879-1609

Provider Enumeration Date	:	01/26/2006
Last Update Date	:	08/22/2020

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