1164696134 NPI number — LABORATORIO CLINICO EL SHADDAI,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 1164696134 NPI number — LABORATORIO CLINICO EL SHADDAI,INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LABORATORIO CLINICO EL SHADDAI,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:
1164696134
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/21/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5005
Provider Second Line Business Mailing Address:
PMB 23
Provider Business Mailing Address City Name:
SAN LORENZO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00754-5005
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-249-5350
Provider Business Mailing Address Fax Number:
787-736-8838

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR 183 # KM7.7
Provider Second Line Business Practice Location Address:
BO. HATO
Provider Business Practice Location Address City Name:
SAN LORENZO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00754-4530
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-249-5350
Provider Business Practice Location Address Fax Number:
787-736-8838
Provider Enumeration Date:
04/21/2008

Additional Information

Authorized Official

Authorized Official Last Name:
ORTIZ
Authorized Official First Name:
CARMEN
Authorized Official Middle Name:
S.
Authorized Official Title or Position:
MEDICAL TECHNOLOGIST
Authorized Official Telephone Number:
787-249-5350

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  1148 , 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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