MEDICARE: LABORATORIO CLINICO CAMPO RICO ,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
1	291U00000X	Clinical Medical Laboratory	786	PR

General Provider Information

NPI Number	:	1659339661
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LABORATORIO CLINICO CAMPO RICO ,INC.

Provider Business Mailing Address
First Line	:	929 AVE ROBERTO SANCHEZ VILELLA
Second Line	:	COUNTRY CLUB
City	:	SAN JUAN
State	:	PR
Zip	:	00924-2585
Country	:	US
Telephone Number	:
Fax Number	:	787-276-0677

Provider Business Practice Location Address
First Line	:	929 ROBERT O SANCHEZ VILELLA AVE.
Second Line	:	COUNTRY CLUB
City	:	SAN JUAN
State	:	PR
Zip	:	00924-2585
Country	:	US
Telephone Number	:	787-762-0655
Fax Number	:	787-276-0677

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MRS. ADA E QUINONES
Credential	:	MEDICAL TECHNOLOGIST
Telephone Number	:	787-762-0655

Provider Enumeration Date	:	05/02/2006
Last Update Date	:	08/22/2020

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