MEDICARE: LABORATORIO CLINICO EL COCO INC

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	1008PRHEALTHDEPT	PR

General Provider Information

NPI Number	:	1346312709
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LABORATORIO CLINICO EL COCO INC

Provider Business Mailing Address
First Line	:	81A CALLE SANTA ANA
Second Line	:	BO COCO NUEVO
City	:	SALINAS
State	:	PR
Zip	:	00751-2621
Country	:	US
Telephone Number	:	787-824-1003
Fax Number	:	787-824-1003

Provider Business Practice Location Address
First Line	:	SANTA ANA 81A
Second Line	:	BO COCO NUEVO
City	:	SALINAS
State	:	PR
Zip	:	00751-3318
Country	:	US
Telephone Number	:	787-824-1003
Fax Number	:	787-824-1003

Authorized Official
Title or Position	:	SUPERVISOR
Name	:	DELMA RODRIGUEZ
Credential	:	BSMT
Telephone Number	:	787-824-1003

Provider Enumeration Date	:	11/14/2006
Last Update Date	:	03/28/2014

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