1750396347 NPI number — LABORATORIO CLINICO METABOLICO CORP.

Table of content: (NPI 1750396347)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750396347 NPI number — LABORATORIO CLINICO METABOLICO CORP.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LABORATORIO CLINICO METABOLICO 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:
1750396347
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/04/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
757 AVE HIPODROMO
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00909-2510
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-723-2807
Provider Business Mailing Address Fax Number:
787-723-2807

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
757 AVE HIPODROMO
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00909-2510
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-723-2807
Provider Business Practice Location Address Fax Number:
787-723-2807
Provider Enumeration Date:
07/30/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HERNANDEZ COBIAN
Authorized Official First Name:
JORGE
Authorized Official Middle Name:
LUIS
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
787-723-2807

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  061 , 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: 0038097 , issued by the state of ( PR ) . This identifiers is of the category "MEDICARE ID-TYPE UNSPECIFIED".