Organization
LABORATORIO TERESITA
Active
Other names
Laboratorio Clinico Ebenezer
Organization subpart
No
Provider details
NPI number
Authorized official
JESSICA ZAMARA GONZALEZ (DUENA)
(787) 675-0112
Entity
Organization
Contact information
Practice address
40 CALLE MUNOZ RIVERA, VEGA ALTA, PR 00692-6530
(787) 883-1009
(787) 883-1009
Mailing address
40 CALLE MUNOZ RIVERA, VEGA ALTA, PR 00692-6530
(787) 883-1009
(787) 883-1009
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
720
PR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20225B
PMC
—
01
—
31282
SSS
—
01
—
66049465902
HUMANA
—
01
—
660494659087
IMC
—
01
—
7620023A
HUMANA
—
01
—
800232
SSS
—
Enumeration date
10/05/2006
Last updated
05/30/2019
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