MEDICARE: MARIA L CRESPO

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	761	PR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	20161	OTHER	PR	PREFERRED MEDICARE CHOCE
6	5599	OTHER	PR	AMERICAN HEALTH MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A0170	OTHER	PR	FIRST PLUS
2	051502	OTHER	PR	BLUE CROSS
3	30731	OTHER	PR	SSS
5	40D0711458	OTHER	PR	CLIA
7	6030045	OTHER	PR	HUMANA HEALTH/ INS
8	0152	OTHER	PR	INTERNATIONAL MEDCAL CARD
9	800386	OTHER	PR	MMM
10	LA0179	OTHER	PR	PAN AMERICAN LIFE

General Provider Information

NPI Number	:	1851324362
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARIA L CRESPO

Provider Business Mailing Address
First Line	:	PO BOX 791
Second Line	:
City	:	SAN ANTONIO
State	:	PR
Zip	:	00690-0791
Country	:	US
Telephone Number	:	787-890-6161
Fax Number	:	787-890-6161

Provider Business Practice Location Address
First Line	:	1065 AVE GENERAL RAMEY
Second Line	:	SUITE 1
City	:	SAN ANTONIO
State	:	PR
Zip	:	00690-1117
Country	:	US
Telephone Number	:	787-890-6161
Fax Number	:	787-890-6161

Authorized Official
Title or Position	:	LABORATORY DIRECTOR
Name	:	MS. MARIA L CRESPO
Credential	:	MTASCP
Telephone Number	:	787-890-6161

Provider Enumeration Date	:	07/08/2006
Last Update Date	:	07/01/2008

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Directions to “MARIA L CRESPO ” Practice Location

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