Organization
I H S CORPORATION
Active
Other names
Laboratorio Clinico Media Luna
Organization subpart
No
Provider details
NPI number
Authorized official
SALOMON A RODRIGUEZ ORTIZ (PRESIDENT)
(787) 794-3939
Entity
Organization
Contact information
Practice address
CARRETERA PRINCIPAL 865 KM 1.3, P 238 BO. CAMPANILLAS, TOA BAJA, PR 00949
(787) 951-8768
Mailing address
CALLE PETIROJO 784, MONTE BELLO, DORADO, PR 00646-3628
(787) 951-8768
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
40D1107086
PR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
039130900
—
PR
01
—
40D1107086
CLIA LABORATORY PROGRAM
PR
Enumeration date
12/28/2009
Last updated
08/28/2023
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