Organization
WAXALI INC
Active
Parent organization
WAXALI INC
Other names
LABORATORIO CLINICO ISLA CENTRO TOA ALTA
Organization subpart
Yes
Provider details
NPI number
Legal business name
WAXALI INC
Authorized official
MR. JOSE L COLLAZO-ROSADO MT (PRESIDENT)
(787) 869-1111
Entity
Organization
Contact information
Practice address
RIO DEL PLATA MALL,URB JARDINES DE TOA ALTA,CALLE # 1, SUITE # 8, TOA ALTA, PR 00953
(787) 545-3200
(787) 545-3201
Mailing address
HC 72 BOX 3954, NARANJITO, PR 00719-8771
(787) 869-1111
(787) 869-2318
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
1248
PR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11-025
CERTIFICADO DE NECESIDAD Y CONVENIENCIA
PR
01
—
1248
LICENCIA ESTATAL PUERTO RICO
PR
01
—
40D2027377
CLIA
PR
Enumeration date
09/13/2011
Last updated
05/12/2014
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