1316021504 NPI number — LABORATORIO CLINICO FAIR VIEW CSP

Table of content: (NPI 1316021504)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316021504 NPI number — LABORATORIO CLINICO FAIR VIEW CSP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LABORATORIO CLINICO FAIR VIEW CSP
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:
1316021504
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/29/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
EL SENORIAL MAIL STATION
Provider Second Line Business Mailing Address:
MSC 779
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00926-6023
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-292-8789
Provider Business Mailing Address Fax Number:
787-292-8757

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARRETERA 845 KM 3.3
Provider Second Line Business Practice Location Address:
CENTRO COMERCIAL FAIRVIEW SUITE 7
Provider Business Practice Location Address City Name:
TRUJILLO ALTO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00976
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-292-8789
Provider Business Practice Location Address Fax Number:
787-292-8757
Provider Enumeration Date:
10/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ORTEGA VERGE
Authorized Official First Name:
LUIS
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER AND ADMINISTRATOR
Authorized Official Telephone Number:
787-292-8789

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  1051 , 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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