MEDICARE: LABORATORIO CLINICO RIO PIEDRAS I

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		PR

General Provider Information

NPI Number	:	1134235690
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LABORATORIO CLINICO RIO PIEDRAS I

Provider Business Mailing Address
First Line	:	1056 CALLE FERROCARRIL
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00925-3028
Country	:	US
Telephone Number	:	787-765-3755
Fax Number	:

Provider Business Practice Location Address
First Line	:	1056 CALLE FERROCARRIL
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00925-3028
Country	:	US
Telephone Number	:	787-765-3755
Fax Number	:

Authorized Official
Title or Position	:	TECNOLOGA MEDICA
Name	:	MRS. LIDIA MERCADO
Credential	:
Telephone Number	:	787-765-3755

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	11/13/2007

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