1649522699 NPI number — LABORATORIO CLINICO Y BACTERIOLOGICO GENESIS

Table of content: (NPI 1649522699)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649522699 NPI number — LABORATORIO CLINICO Y BACTERIOLOGICO GENESIS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LABORATORIO CLINICO Y BACTERIOLOGICO GENESIS
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:
1649522699
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/15/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
EDIF. LA FUENTE TOWN CENTER SUITE 108
Provider Second Line Business Mailing Address:
CARR. NUM. PR 54, KM 0.9 MACHETE
Provider Business Mailing Address City Name:
GUAYAMA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00784
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-866-6470
Provider Business Mailing Address Fax Number:
787-866-6471

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR NUM 54 KM 0.9 MACHETE
Provider Second Line Business Practice Location Address:
SUITE 108 EDIF LA FUENTE TOWN CENTER
Provider Business Practice Location Address City Name:
GUAYAMA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00784
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-866-6470
Provider Business Practice Location Address Fax Number:
787-866-6471
Provider Enumeration Date:
10/15/2012

Additional Information

Authorized Official

Authorized Official Last Name:
CARRASQUILLO
Authorized Official First Name:
LUIS
Authorized Official Middle Name:
MANUEL
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
787-839-9393

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  1075 , 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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