Provider Demographics
NPI:1619287976
Name:DVW CLINICAL LABORATORIES SERVICES
Entity Type:Organization
Organization Name:DVW CLINICAL LABORATORIES SERVICES
Other - Org Name:LAB CLINICO CAMUY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL TECHNOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:VELAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-898-5645
Mailing Address - Street 1:4 CALLE INFANZON
Mailing Address - Street 2:
Mailing Address - City:CAMUY
Mailing Address - State:PR
Mailing Address - Zip Code:00627-2627
Mailing Address - Country:US
Mailing Address - Phone:787-898-5645
Mailing Address - Fax:787-898-5645
Practice Address - Street 1:4 CALLE INFANZON
Practice Address - Street 2:
Practice Address - City:CAMUY
Practice Address - State:PR
Practice Address - Zip Code:00627-2627
Practice Address - Country:US
Practice Address - Phone:787-898-5645
Practice Address - Fax:787-898-5645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-20
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR444291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory