Organization
LABORATORIO CLINICO EBENEZER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ENILDA VELAZQUEZ PB MT, MLS (ASCP) (OWNER)
(787) 233-1313
Entity
Organization
Contact information
Practice address
PR 8860 KM 1.2, PLAZA MATIENZO BO CUEVAS, TRUJILLO ALTO, PR 00976
(787) 233-1313
Mailing address
2C25 AVE C, CAROLINA, PR 00987-7481
(787) 220-1558
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1255788386
—
PR
Enumeration date
03/20/2019
Last updated
03/20/2019
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