# CLINICAL & LABORATORY MANAGEMENT

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1174756704
- **Authorized official:** MRS. COLLAZO ORTIZ MARISOL MT MS (EJECUTIVE DIRECTOR)
- **Authorized official phone:** (787) 739-2054

## Contact information

- **Practice address:** STREET BARCELO NUM 12 CORNER 173 CIDRA PR 00739, PMB 1111 BOX 6400, CAYEY, PR 00737-6400
- **Practice address phone:** (797) 739-2054
- **Practice address fax:** (787) 739-5525
- **Mailing address:** CALLE BARCELO NUM 12 ESQ CARR 173 CIDRA, PR, PMB 1111 BOX 6400, CAYEY, PR 00737-6400
- **Mailing address phone:** (787) 739-2054
- **Mailing address fax:** (787) 739-5525

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | 122 | PR | Yes |

## Other

- **Enumeration date:** 08/31/2009
- **Last updated:** 08/31/2009