1790909265 NPI number — LABORATORIO CLINICO Y DE REFERENCIA DE FAJARDO, INC.

Table of content: (NPI 1790909265)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790909265 NPI number — LABORATORIO CLINICO Y DE REFERENCIA DE FAJARDO, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LABORATORIO CLINICO Y DE REFERENCIA DE FAJARDO, 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:
LABORATORIO CLINICO SAN FERNANDO
Provider Other Organization Name Type Code:
3
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:
1790909265
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/25/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
210 AVE LAURO PINERO
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CEIBA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00735-2737
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-885-0813
Provider Business Mailing Address Fax Number:
787-885-0831

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
303 GENERAL VALERO AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAJARDO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00738-7006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-885-0813
Provider Business Practice Location Address Fax Number:
787-885-0831
Provider Enumeration Date:
04/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LOPEZ
Authorized Official First Name:
SARA
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
787-885-0813

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  850 , 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)





Copyright © 2007-2024 www.npivalidator.com