1124164140 NPI number — LABORATORIO CLINICO COVADONGA,INC

Table of content: WARREN J. BAYNES SR. LMSW (NPI 1952908006)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124164140 NPI number — LABORATORIO CLINICO COVADONGA,INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LABORATORIO CLINICO COVADONGA,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:
1124164140
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/30/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
AA4 AVE DON PELAYO
Provider Second Line Business Mailing Address:
HACIENDAS DEL NORTE
Provider Business Mailing Address City Name:
TOA BAJA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00949-5388
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-251-0138
Provider Business Mailing Address Fax Number:
787-251-0130

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
AA4 AVE DON PELAYO
Provider Second Line Business Practice Location Address:
HACIENDAS DEL NORTE
Provider Business Practice Location Address City Name:
TOA BAJA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00949-5388
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-251-0138
Provider Business Practice Location Address Fax Number:
787-251-0130
Provider Enumeration Date:
01/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SANTIAGO
Authorized Official First Name:
LILLIAN
Authorized Official Middle Name:
Authorized Official Title or Position:
SUPERVISOR
Authorized Official Telephone Number:
787-251-0138

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  00758 , 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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