1528126778 NPI number — LABORATORIO CLINICO Y BACTERIOLOGICO ORIENTAL INC

Table of content: KENNETH EUGENE CLARK COTA (NPI 1063887834)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528126778 NPI number — LABORATORIO CLINICO Y BACTERIOLOGICO ORIENTAL INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LABORATORIO CLINICO Y BACTERIOLOGICO ORIENTAL 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:
1528126778
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/13/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 10034 CUH STATION
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUMACAO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00792
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-850-6045
Provider Business Mailing Address Fax Number:
787-850-6045

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CALLE 13 BC 1 URB VILLA UNIVERSITARIA
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUMACAO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00791
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-850-6045
Provider Business Practice Location Address Fax Number:
787-850-6045
Provider Enumeration Date:
12/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SANTIAGO
Authorized Official First Name:
LISETTE
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
787-850-6045

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  779 , 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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