1043329873 NPI number — LABORATORIO CLINICO PUJOLS, INC.

Table of content: (NPI 1043329873)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043329873 NPI number — LABORATORIO CLINICO PUJOLS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LABORATORIO CLINICO PUJOLS, INC.
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:
1043329873
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 3692
Provider Second Line Business Mailing Address:
HATO ARRIBA STATION
Provider Business Mailing Address City Name:
SAN SEBASTIAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00685-7012
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-896-7381
Provider Business Mailing Address Fax Number:
787-896-7381

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR. 111 KM. 17.0
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN SEBASTIAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00685-7012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-896-7381
Provider Business Practice Location Address Fax Number:
787-896-7381
Provider Enumeration Date:
08/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SOTO
Authorized Official First Name:
DAISY
Authorized Official Middle Name:
IVETTE
Authorized Official Title or Position:
ADMINISTRADORA
Authorized Official Telephone Number:
787-896-7381

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  1022 , 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)

  • Identifier: 40D0982044 . This is a "CLIA NUMBER" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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