MEDICARE: MRS. IRIS M COLON VARGAS MT

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	246QM0706X	Medical Technologist	651	PR

General Provider Information

NPI Number	:	1639168420
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. IRIS M COLON VARGAS MT

Provider Business Mailing Address
First Line	:	75 CALLE KRUG
Second Line	:	LABORATORIO TORREGROSA
City	:	SAN JUAN
State	:	PR
Zip	:	00911-1619
Country	:	US
Telephone Number	:	787-728-5959
Fax Number	:	787-728-5959

Provider Business Practice Location Address
First Line	:	75 CALLE KRUG
Second Line	:	LABORATORIO TORREGROSA
City	:	SAN JUAN
State	:	PR
Zip	:	00911-1619
Country	:	US
Telephone Number	:	787-728-5959
Fax Number	:	787-728-5959

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/14/2005
Last Update Date	:	08/28/2012

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