MEDICARE: LABORATORIO CLINICO ANA CAMILA

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	1318	PR

General Provider Information

NPI Number	:	1144627241
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LABORATORIO CLINICO ANA CAMILA

Provider Business Mailing Address
First Line	:	PR-3 KM 158-.5 SUITE B
Second Line	:	URB. MINIMA LA CARMEN
City	:	SALINAS
State	:	PR
Zip	:	00751-2319
Country	:	US
Telephone Number	:	787-421-6666
Fax Number	:	787-824-4333

Provider Business Practice Location Address
First Line	:	PR 3 KM 158.5
Second Line	:	URB. MINIMA LA CARMEN
City	:	SALINAS
State	:	PR
Zip	:	00751-2319
Country	:	US
Telephone Number	:	787-421-6666
Fax Number	:	787-824-4333

Authorized Official
Title or Position	:	MEDICAL TECHNOLOGY
Name	:	JOHANNY ORTIZ LOPEZ
Credential	:
Telephone Number	:	787-421-6666

Provider Enumeration Date	:	12/04/2014
Last Update Date	:	12/04/2014

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