Basic Information
| Provider Information | |||||||||
| NPI: | 1376136069 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | QUEST DIAGNOSTICS OF PUERTO RICO, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 107 AVE ORTEGON STE 103 | ||||||||
| Address2: | |||||||||
| City: | GUAYNABO | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009662516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7874742900 | ||||||||
| FaxNumber: | 7877655663 | ||||||||
| Practice Location | |||||||||
| Address1: | 85 CALLE DON CHEMARY | ||||||||
| Address2: | |||||||||
| City: | MOCA | ||||||||
| State: | PR | ||||||||
| PostalCode: | 006764120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7874742900 | ||||||||
| FaxNumber: | 7877655663 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2021 | ||||||||
| LastUpdateDate: | 02/15/2021 | ||||||||
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| AuthorizedOfficialLastName: | ESPINOSA | ||||||||
| AuthorizedOfficialFirstName: | OMAYRA | ||||||||
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| AuthorizedOfficialTitleorPosition: | BILLING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7874742900 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | QUEST DIAGNOSTICS OF PUERTO RICO, INC | ||||||||
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| NPICertificationDate: | 02/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | Y | Laboratories | Clinical Medical Laboratory |
No ID Information.