MEDICARE: JAIXA E LANTIGUA

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	246QM0900X	Microbiology Specialist/Technologist

General Provider Information

NPI Number	:	1437000254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAIXA E LANTIGUA

Provider Business Mailing Address
First Line	:	2630 ELBRIDGE ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19149-2909
Country	:	US
Telephone Number	:	267-516-7847
Fax Number	:

Provider Business Practice Location Address
First Line	:	2630 ELBRIDGE ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19149-2909
Country	:	US
Telephone Number	:	267-516-7847
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2026
Last Update Date	:	02/06/2026

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Directions to “ JAIXA E LANTIGUA ” Practice Location

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