40D0951327 CLIA NUMBER - OCTAVIO JORDAN MD

Laboratory Demographics

CLIA Number: 40D0951327

Facility Name: OCTAVIO JORDAN MD

Facility Address:
EDIF MEDICO SANTA CRUZ #73 OFICINA 313
BAYAMON, PR
ZIP 00961
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Facility Phone Number: 787 780-7832

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1760475024

Taxonomy: 174400000X - Specialist
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

CLIA Record

Field Name	Field Value
CLIA Number	40D0951327
LAB Type	Physician Office
Facility Name	OCTAVIO JORDAN MD
Street	EDIF MEDICO SANTA CRUZ #73 OFICINA 313
City	BAYAMON
State	PR
ZIP	00961
Phone	787 780-7832
CertificateType	4
CertificateEffectiveDate	9/16/2022
CertificateExpirationDate	9/15/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024