MEDICARE: LABORATORIO CLINICO BORINQUEN-SAN FRANCISCO

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	664	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	664	OTHER	PR	LICENSE

General Provider Information

NPI Number	:	1598874315
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LABORATORIO CLINICO BORINQUEN-SAN FRANCISCO

Provider Business Mailing Address
First Line	:	2 CALLE BALDORIOTY
Second Line	:
City	:	CAGUAS
State	:	PR
Zip	:	00725-2606
Country	:	US
Telephone Number	:	787-744-0330
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 AVE DE DIEGO
Second Line	:	OFICINA 6
City	:	SAN JUAN
State	:	PR
Zip	:	00927-5815
Country	:	US
Telephone Number	:	787-773-6338
Fax Number	:	787-763-3545

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MS. KIMBERLY JEAN WHITLOCK
Credential	:
Telephone Number	:	787-744-0330

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	08/22/2020

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