MEDICARE: LABORATORIO CLINICO IRIZARRY GUASCH 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

General Provider Information

NPI Number	:	1841022191
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LABORATORIO CLINICO IRIZARRY GUASCH INC

Provider Business Mailing Address
First Line	:	PO BOX 593
Second Line	:
City	:	LAJAS
State	:	PR
Zip	:	00667-0593
Country	:	US
Telephone Number	:	787-899-7223
Fax Number	:	787-899-1861

Provider Business Practice Location Address
First Line	:	21 CALLE BALDORIOTY
Second Line	:
City	:	COAMO
State	:	PR
Zip	:	00769-2412
Country	:	US
Telephone Number	:	787-825-4140
Fax Number	:	787-899-1861

Authorized Official
Title or Position	:	SECRETARY
Name	:	MRS. NILSA I IRIZARRY GUASCH
Credential	:
Telephone Number	:	787-899-7223

Provider Enumeration Date	:	08/15/2024
Last Update Date	:	08/15/2024

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