MEDICARE: LABORATORIO CLINICO LAS COLINAS 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	1005	PR

General Provider Information

NPI Number	:	1477633220
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LABORATORIO CLINICO LAS COLINAS INC.

Provider Business Mailing Address
First Line	:	35 CALLE JUAN C BORBON
Second Line	:	SUITE 69
City	:	GUAYNABO
State	:	PR
Zip	:	00969-5374
Country	:	US
Telephone Number	:	787-287-0645
Fax Number	:	787-287-0979

Provider Business Practice Location Address
First Line	:	CENTRO COMERCIAL JARDINES REALES
Second Line	:	AVE. LAS CUMBRES ESQUINA CALLE JUAN C. BORBON
City	:	GUAYNABO
State	:	PR
Zip	:	00969-5374
Country	:	US
Telephone Number	:	787-287-0645
Fax Number	:	787-287-0979

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MRS. NILSA MARRERO
Credential	:	MEDICAL TECHNOLOGIST
Telephone Number	:	787-287-0645

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	08/24/2020

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