1023000361 NPI number — LABORATORIO CLINICO TINTILLO

Table of content: (NPI 1023000361)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023000361 NPI number — LABORATORIO CLINICO TINTILLO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LABORATORIO CLINICO TINTILLO
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023000361
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/26/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 194690
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00919-4690
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-783-5686
Provider Business Mailing Address Fax Number:
787-707-0818

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12 CALLE BUEN SAMARITANO
Provider Second Line Business Practice Location Address:
JUAN DOMINGO
Provider Business Practice Location Address City Name:
GUAYNABO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00966-7934
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-783-5686
Provider Business Practice Location Address Fax Number:
787-707-0818
Provider Enumeration Date:
08/22/2005

Additional Information

Authorized Official

Authorized Official Last Name:
POU
Authorized Official First Name:
MARLEN
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
787-783-5686

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  552 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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