MEDICARE: LABORATORIO CLINICO LARACUENTE

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	535	PR

General Provider Information

NPI Number	:	1528285962
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LABORATORIO CLINICO LARACUENTE

Provider Business Mailing Address
First Line	:	CALLE MENDEZ VIGO # 291
Second Line	:
City	:	DORADO
State	:	PR
Zip	:	00646-4924
Country	:	US
Telephone Number	:	787-796-1003
Fax Number	:	787-796-1003

Provider Business Practice Location Address
First Line	:	CALLE MENDEZ VIGO # 291
Second Line	:
City	:	DORADO
State	:	PR
Zip	:	00646-4924
Country	:	US
Telephone Number	:	787-796-1003
Fax Number	:	787-796-1003

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. SONIA LARACUENTE
Credential	:
Telephone Number	:	787-796-1003

Provider Enumeration Date	:	04/19/2007
Last Update Date	:	08/07/2008

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