MEDICARE: LABORATORIO CLINICO LEVITTOWN, 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	310	PR

General Provider Information

NPI Number	:	1457354011
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LABORATORIO CLINICO LEVITTOWN, INC.

Provider Business Mailing Address
First Line	:	PO BOX 51903
Second Line	:
City	:	TOA BAJA
State	:	PR
Zip	:	00950-1903
Country	:	US
Telephone Number	:	787-784-0813
Fax Number	:	787-795-5330

Provider Business Practice Location Address
First Line	:	S-15 CALLE LEALTAD LEVITTOWN
Second Line	:
City	:	TOA BAJA
State	:	PR
Zip	:	00949
Country	:	US
Telephone Number	:	787-784-0813
Fax Number	:	787-795-5330

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MRS. KENNY LORENZANA
Credential	:	M.T.
Telephone Number	:	787-784-0813

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	06/27/2008

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