Provider Demographics
NPI:1962643577
Name:ARBOLEDA, JERUSHA (MT (ASCP))
Entity Type:Individual
Prefix:MISS
First Name:JERUSHA
Middle Name:
Last Name:ARBOLEDA
Suffix:
Gender:F
Credentials:MT (ASCP)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:C-2 ALEJANDRINO - CLEMENTINA
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-4704
Mailing Address - Country:US
Mailing Address - Phone:787-503-1304
Mailing Address - Fax:787-200-0391
Practice Address - Street 1:C-2 ALEJANDRINO - CLEMENTINA
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-4704
Practice Address - Country:US
Practice Address - Phone:787-503-1304
Practice Address - Fax:787-200-0391
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-11
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR447291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
3-0127OtherSSS
660-125278OtherMCS
660-125278OtherMCS