1811172828 NPI number — LABORATORIO CLINICO EL CONQUISTADOR I 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 1811172828 NPI number — LABORATORIO CLINICO EL CONQUISTADOR I INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LABORATORIO CLINICO EL CONQUISTADOR I 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:
1811172828
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/12/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
CALLE CASTELLON 734 UBANIZACION VISTAMAR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAROLINA
Provider Business Mailing Address State Name:
PUERTO RICO
Provider Business Mailing Address Postal Code:
00983
Provider Business Mailing Address Country Code:
UM
Provider Business Mailing Address Telephone Number:
787-646-4608
Provider Business Mailing Address Fax Number:
787-888-4774

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CENTRO COMERCIAL EL CONQUISTADOR PLAZA COURT
Provider Second Line Business Practice Location Address:
CARR. 190, KM 0.7, MARGINAL BALDORIOTY DE CASTRO
Provider Business Practice Location Address City Name:
CAROLINA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00985
Provider Business Practice Location Address Country Code:
UM
Provider Business Practice Location Address Telephone Number:
787-752-2228
Provider Business Practice Location Address Fax Number:
787-752-2715
Provider Enumeration Date:
01/09/2008

Additional Information

Authorized Official

Authorized Official Last Name:
GONZALEZ
Authorized Official First Name:
WANDA
Authorized Official Middle Name:
DAMARIS
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-646-4608

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  1145 , 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: 1145 . This is a "HEALTH DEPARTMENT" identifier . This identifiers is of the category "OTHER".




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