1609643972 NPI number — HIGH PROFILE LABORATORIES TESTING SERVICES LLC

Table of content: (NPI 1609643972)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609643972 NPI number — HIGH PROFILE LABORATORIES TESTING SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HIGH PROFILE LABORATORIES TESTING SERVICES LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
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Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
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Provider Other Last Name:
Provider Other First Name:
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NPI Number Information

NPI Number:
1609643972
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
405 AVE ESMERALDA, PMB 355
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GUAYNABO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00969-4482
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-720-0760
Provider Business Mailing Address Fax Number:
787-720-0760

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
#1 AVE CASA LINDA, SALUS, STE 103
Provider Second Line Business Practice Location Address:
CARR 177, AVE LOS FILTROS
Provider Business Practice Location Address City Name:
BAYAMON
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00959-9002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-720-0760
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/07/2023

Additional Information

Authorized Official

Authorized Official Last Name:
RIPOLL
Authorized Official First Name:
CARMEN
Authorized Official Middle Name:
Authorized Official Title or Position:
LABORATORY DIRECTOR
Authorized Official Telephone Number:
787-720-0767

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)





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