MEDICARE: DAVID VELAZQUEZ CAMARENA LABORATORIO CLINICO DAJAOS

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	616	PR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0031290	OTHER	PR	MEDICARE PROVIDER

General Provider Information

NPI Number	:	1518939081
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID VELAZQUEZ CAMARENA LABORATORIO CLINICO DAJAOS

Provider Business Mailing Address
First Line	:	PO BOX 1815
Second Line	:
City	:	BAYAMON
State	:	PR
Zip	:	00960-1815
Country	:	US
Telephone Number	:	787-786-6209
Fax Number	:	787-269-1378

Provider Business Practice Location Address
First Line	:	CARR 167 # KM11.0
Second Line	:	BO. DAJAOS
City	:	BAYAMON
State	:	PR
Zip	:	00956-9212
Country	:	US
Telephone Number	:	787-730-1195
Fax Number	:	787-730-1195

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MRS. MARIA I PRADOS
Credential	:	MT
Telephone Number	:	787-730-1195

Provider Enumeration Date	:	02/07/2006
Last Update Date	:	10/03/2013

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