MEDICARE: TILIA,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	118	PR

General Provider Information

NPI Number	:	1881661114
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TILIA,INC.

Provider Business Mailing Address
First Line	:	400 AVE DOMENECH
Second Line	:	LAS AMERICAS PROFESSIONAL CENTER
City	:	SAN JUAN
State	:	PR
Zip	:	00918-3710
Country	:	US
Telephone Number	:	787-753-7155
Fax Number	:	787-753-7756

Provider Business Practice Location Address
First Line	:	400 AVE DOMENECH
Second Line	:	LAS AMERICAS PROFESSIONAL CENTER
City	:	SAN JUAN
State	:	PR
Zip	:	00918-3710
Country	:	US
Telephone Number	:	787-753-7155
Fax Number	:	787-753-7756

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. ILIA M. MARTINEZ
Credential	:	B.S.M.T.
Telephone Number	:	787-753-7155

Provider Enumeration Date	:	03/06/2006
Last Update Date	:	08/22/2020

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