MEDICARE: LABORATORIO CLINICO NORTH MAIN

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	679	PR

General Provider Information

NPI Number	:	1699791194
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LABORATORIO CLINICO NORTH MAIN

Provider Business Mailing Address
First Line	:	2 CALLE BALDORIOTY
Second Line	:
City	:	CAGUAS
State	:	PR
Zip	:	00725-2606
Country	:	US
Telephone Number	:	787-743-0330
Fax Number	:	787-744-2588

Provider Business Practice Location Address
First Line	:	31-15 AVE NORTH MAIN
Second Line	:
City	:	BAYAMON
State	:	PR
Zip	:	00961-4328
Country	:	US
Telephone Number	:	787-798-6776
Fax Number	:	787-269-1875

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MS. KIMBERLY J WHITLOCK
Credential	:
Telephone Number	:	787-743-0330

Provider Enumeration Date	:	07/15/2006
Last Update Date	:	08/22/2020

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