MEDICARE: LABORATORIO CLINICO MARGARITA

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	278	PR

General Provider Information

NPI Number	:	1962470047
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LABORATORIO CLINICO MARGARITA

Provider Business Mailing Address
First Line	:	1017 AVE GENERAL DEL VALLE
Second Line	:	URB DELICIAS
City	:	SAN JUAN
State	:	PR
Zip	:	00924
Country	:	US
Telephone Number	:	787-764-7153
Fax Number	:	787-751-6887

Provider Business Practice Location Address
First Line	:	1017 AVE GENERAL DEL VALLE
Second Line	:	URB DELICIAS
City	:	SAN JUAN
State	:	PR
Zip	:	00924
Country	:	US
Telephone Number	:	787-764-7153
Fax Number	:	787-751-6887

Authorized Official
Title or Position	:	PRESIDENT AND DIRECTOR
Name	:	MRS. LUISA M GARCIA
Credential	:	MT
Telephone Number	:	787-751-6887

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	01/22/2008

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