MEDICARE: LABORATORIO CLINICO ANIBEL

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	0268	PR

General Provider Information

NPI Number	:	1558534099
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LABORATORIO CLINICO ANIBEL

Provider Business Mailing Address
First Line	:	8 CALLE YAGUEZ
Second Line	:	ESTANCIAS DEL RIO
City	:	AGUAS BUENAS
State	:	PR
Zip	:	00703-9620
Country	:	US
Telephone Number	:	787-767-4694
Fax Number	:	787-763-4347

Provider Business Practice Location Address
First Line	:	724 AVE PONCE DE LEON
Second Line	:	HATO REY
City	:	SAN JUAN
State	:	PR
Zip	:	00918-4512
Country	:	US
Telephone Number	:	787-767-4694
Fax Number	:	787-763-4347

Authorized Official
Title or Position	:	DIRECTOR/OWNER
Name	:	MARIBEL TORRES
Credential	:
Telephone Number	:	787-767-4694

Provider Enumeration Date	:	04/04/2008
Last Update Date	:	06/19/2008

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