1184068140 NPI number — LABORATORIO CLINICO LA MONSERRATE CORP.

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 1184068140 NPI number — LABORATORIO CLINICO LA MONSERRATE CORP.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LABORATORIO CLINICO LA MONSERRATE CORP.
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:
1184068140
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/15/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1338
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HORMIGUEROS
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00660-5338
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-378-0653
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
345 CALLE RAMON EMETERIO BETANCES
Provider Second Line Business Practice Location Address:
EDIF. COMERCIAL BELMONTE CENTRO
Provider Business Practice Location Address City Name:
MAYAGUEZ
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00680
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-378-0653
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/22/2013

Additional Information

Authorized Official

Authorized Official Last Name:
TROCHE
Authorized Official First Name:
JEANNETTE
Authorized Official Middle Name:
SARAHI
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-378-0653

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  1280 , 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: 40D2054127 . This is a "CLIA ID NUMBER" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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