1639169006 NPI number — LABORATORIO CLINICO PLAZA REAL INC

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 1639169006 NPI number — LABORATORIO CLINICO PLAZA REAL INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LABORATORIO CLINICO PLAZA REAL 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:
1639169006
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/01/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 AVE ARBOLOTE
Provider Second Line Business Mailing Address:
SUITE 302 PLAZA REAL MALL
Provider Business Mailing Address City Name:
GUAYNABO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00969-2806
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-720-1444
Provider Business Mailing Address Fax Number:
787-963-0446

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 AVE ARBOLOTE
Provider Second Line Business Practice Location Address:
SUITE 302 PLAZA REAL MALL
Provider Business Practice Location Address City Name:
GUAYNABO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00969-2806
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-720-1444
Provider Business Practice Location Address Fax Number:
787-963-0446
Provider Enumeration Date:
10/26/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SANTIAGO
Authorized Official First Name:
RAFAEL
Authorized Official Middle Name:
E
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
787-720-1444

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  702 , 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: 6570083 . This is a "HUMANA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: L-400141 . This is a "PREFERRED HEALTH PLAN" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 800220 . This is a "MMM PROVIDER NUMBER" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 051307 . This is a "CRUZ AZUL DE PR" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 20213 . This is a "AMERICAN HEALTH" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 30716 . This is a "SSS" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 1271 . This is a "INTERNATIONAL MEDICAL CAR" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 20278 . This is a "PREFERRED MEDICAL CHOICE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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