1588730923 NPI number — LABORATORIO CLINICO DEL PARQUE INC

Table of content: (NPI 1588730923)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588730923 NPI number — LABORATORIO CLINICO DEL PARQUE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LABORATORIO CLINICO DEL PARQUE 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:
1588730923
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/31/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 41028
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:
00940-1028
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-724-4161
Provider Business Mailing Address Fax Number:
787-724-4161

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
352 CALLE DEL PARQUE
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:
00912-3702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-724-4161
Provider Business Practice Location Address Fax Number:
787-724-4161
Provider Enumeration Date:
11/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HIRALDO
Authorized Official First Name:
CARLOS
Authorized Official Middle Name:
M
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
787-724-4161

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 20137 . This is a "AMERICAN HEALTH INC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 660491943 . This is a "AMERICAN HEALTH MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9090086 . This is a "HUMANA HMO POS MEDICAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 660491943 . This is a "HUMANA GOLD CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 660491943 . This is a "MEDICAL CARD SYSTEM REFOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 660491943 . This is a "OPTION HEALTH CARE NETWOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9090086 . This is a "HUMANA HEALTH PLAN OF PR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 051667 . This is a "LA CRUZ AZUL DE PUERTO RI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 660491943 . This is a "COSVIMED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 660491943 . This is a "CIGNA PROVIDER SERVICES" identifier . This identifiers is of the category "OTHER".
  • Identifier: 660491943 . This is a "MAPFRE EXCEL" identifier . This identifiers is of the category "OTHER".
  • Identifier: LA037 . This is a "PAN AMERICAN LIFE INS CO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 660491943 . This is a "MCS CLASSICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 660491943 . This is a "MEDICAL CARD SYSTEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 800464 . This is a "MMM HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 400322 . This is a "PREFERRED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 660491943 . This is a "INTERNATIONAL MEDICAL CAR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 660491943 . This is a "MAPFRE LIFE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 660491943 . This is a "PALIC PROVIDER NETWORK" identifier . This identifiers is of the category "OTHER".




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