Taxonomy Codes
                        The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
                        
                            
                                
                                    
                                        | No. | Taxonomy Code | Taxonomy Clasification | Taxonomy Specialization | License Number | License State | Primary | 
                                
                                
                                    | 1 | 291U00000X | Clinical Medical Laboratory |  | 236 | PUERTO RICO | Yes | 
                                
                            
                         
                     
                    
                        
                            Other Identifiers
                            The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
                            
                                
                                    
                                        
                                            | No. | Other Provider Identifier | Other Provider Identifier Type | Other Provider Identifier State | Other Provider Identifier Issuer | 
                                    
                                    
                                        | 1 | 30955 | OTHER | PUERTO RICO | MEDICARE OPTIMO | 
| 2 | 30955 | OTHER | PUERTO RICO | SSS & SSS REFORMA | 
| 3 | ITIN | OTHER | PUERTO RICO | MCS & MCS REFORMA | 
| 4 | 1100105 | OTHER | PUERTO RICO | HUMANA | 
| 5 | LA0351 | OTHER | PUERTO RICO | PALIC-PANAMERICAN LIFE | 
| 6 | 6007449 | OTHER | PUERTO RICO | ACAA | 
| 7 | ITIN | OTHER | PUERTO RICO | CIGNA & CIGNA EXCLUSIVE | 
| 8 | 20408 | OTHER | PUERTO RICO | PREFERRED MEDICARE CHOICE | 
| 9 | 400337 | OTHER | PUERTO RICO | UTI- PREFFERED HEALTH | 
| 10 | 800219 | OTHER | PUERTO RICO | MEDICARE Y MUCHO MAS- MMM | 
| 11 | ITIN | OTHER | PUERTO RICO | OPTION HEALTHCARE | 
| 12 | 20024 | OTHER | PUERTO RICO | AMERICAN HEALTH | 
| 13 | 11236 | OTHER | PUERTO RICO | GLOBAL HEALTH | 
| 14 | 8397 | OTHER | PUERTO RICO | FIRST MEDICAL- IMC | 
| 15 | ITIN | OTHER | PUERTO RICO | MAPFRE & MAPFRE MEDICARE | 
| 16 | 51652 | OTHER | PUERTO RICO | CRUZ AZUL | 
| 17 | 30955 | MEDICARE PIN | PUERTO RICO |  |