Organization
LABORATORIO CLINICO LUQUILLO, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. WANDA I AVILES M.T. (GENERAL SUPERVISOR)
(787) 648-9360
Entity
Organization
Contact information
Practice address
CALLE 13 PARCELA # 52, BARRIO FORTUNA LL, LUQUILLO, PR 00773
(787) 534-4329
(787) 534-6586
Mailing address
40 CARR 194 STE 100, FDO CINEMA BLDG, FAJARDO, PR 00738-2927
(787) 534-4329
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
1337
PR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
40 D 2105017
CLIA ID NUMBER
PR
Enumeration date
03/21/2016
Last updated
10/03/2016
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