MEDICARE: TERESITA LAB LLC

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

General Provider Information

NPI Number	:	1427911718
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TERESITA LAB LLC

Provider Business Mailing Address
First Line	:	MIRABELLA VILLAGE CALLE CUARZO 23A
Second Line	:
City	:	BAYAMON
State	:	PR
Zip	:	00961
Country	:	US
Telephone Number	:	787-675-0112
Fax Number	:	787-675-0112

Provider Business Practice Location Address
First Line	:	AVE JESUS T PINERO
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00927-6704
Country	:	US
Telephone Number	:	787-675-0112
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	JESSICA Z GONZALEZ QUIJANO
Credential	:
Telephone Number	:	787-675-0112

Provider Enumeration Date	:	12/04/2025
Last Update Date	:	12/04/2025

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Directions to “TERESITA LAB LLC ” Practice Location

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