1427143007 NPI number — LABORATORIO CLINICO GUAYANILLENSE CSP

Table of content: (NPI 1427143007)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427143007 NPI number — LABORATORIO CLINICO GUAYANILLENSE CSP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LABORATORIO CLINICO GUAYANILLENSE CSP
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:
1427143007
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/01/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
MUNOZ RIVERA
Provider Second Line Business Mailing Address:
#135
Provider Business Mailing Address City Name:
GUAYANILLA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00656
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-835-3209
Provider Business Mailing Address Fax Number:
787-835-3283

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
MUNOZ RIVERA
Provider Second Line Business Practice Location Address:
#135
Provider Business Practice Location Address City Name:
GUAYANILLA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00656
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-835-3209
Provider Business Practice Location Address Fax Number:
787-835-3283
Provider Enumeration Date:
10/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PACHECO
Authorized Official First Name:
ILEANA
Authorized Official Middle Name:
MARIA
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
787-835-3209

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  0551 , 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: 0038216 . This is a "MEDICARE PROVIDER" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 40D0658094 . This is a "CLIA NUMBER" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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