1174803894 NPI number — LABORATORIO CLINICO Y BACTERIOLOGICO GENESIS II

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174803894 NPI number — LABORATORIO CLINICO Y BACTERIOLOGICO GENESIS II

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LABORATORIO CLINICO Y BACTERIOLOGICO GENESIS II
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:
1174803894
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/25/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 986
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PATILLAS
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00723-0986
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-839-9393
Provider Business Mailing Address Fax Number:
787-839-9344

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR NUM 3
Provider Second Line Business Practice Location Address:
KM 122 HM 6
Provider Business Practice Location Address City Name:
PATILLAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00723
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-839-9393
Provider Business Practice Location Address Fax Number:
787-839-9344
Provider Enumeration Date:
08/25/2011

Additional Information

Authorized Official

Authorized Official Last Name:
CARRASQUILLO
Authorized Official First Name:
LUIS
Authorized Official Middle Name:
MANUEL
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
787-839-9393

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  1226 , 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: 0031132 . This is a "MEDICARE ID-TYPE UNSPECIFIED" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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