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NPI Code Detail

MEDICARE: CENTER DIAGNOSTIC LABORATORY,INC

MEDICARE: CENTER DIAGNOSTIC LABORATORY,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
1291U00000XClinical Medical Laboratory215PR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1400048OTHERPRPREFERRED HEALTH
2051349OTHERPRLA CRUZ AZUL DE PR
30023OTHERPRPALIC
46933OTHERPRFIRST MEDICAL
530608CEOTHERPRTRIPLE S, INC
69210021OTHERPRHUMANA

General Provider Information

NPI Number : 1639162977
Entity Type Code : Organization
Provider Name (Legal Business Name) : CENTER DIAGNOSTIC LABORATORY,INC
Provider Business Mailing Address
First Line : 1251 AVE AMERICO MIRANDA
Second Line : REPARTO METROPOLITANO
City : SAN JUAN
State : PR
Zip : 00921-1619
Country : US
Telephone Number : 787-781-2016
Fax Number :
Provider Business Practice Location Address
First Line : 1251 AVE AMERICO MIRANDA
Second Line : REPARTO METROPOLITANO
City : SAN JUAN
State : PR
Zip : 00921-1619
Country : US
Telephone Number : 787-781-2016
Fax Number :
Authorized Official
Title or Position : SUPERVISOR
Name : EMILIA BERRIOS
Credential : MT
Telephone Number : 787-781-2016
Provider Enumeration Date : 08/23/2005
Last Update Date : 08/22/2020

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Directions to “CENTER DIAGNOSTIC LABORATORY,INC ” Practice Location

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