1760789556 NPI number — EASTERN VALLEY CLINICAL LABORATORIES, INC.

Table of content: (NPI 1760789556)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760789556 NPI number — EASTERN VALLEY CLINICAL LABORATORIES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EASTERN VALLEY CLINICAL LABORATORIES, 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:
6
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:
1760789556
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/25/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10 CALLE ICACOS
Provider Second Line Business Mailing Address:
THE VILLAGE AT THE HILL
Provider Business Mailing Address City Name:
CEIBA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00735-3902
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-398-4758
Provider Business Mailing Address Fax Number:
787-655-7755

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR 976 KM 2.7
Provider Second Line Business Practice Location Address:
BO FLORENCIO
Provider Business Practice Location Address City Name:
FAJARDO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00738
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-655-7755
Provider Business Practice Location Address Fax Number:
787-655-7755
Provider Enumeration Date:
02/15/2011

Additional Information

Authorized Official

Authorized Official Last Name:
PACHECO
Authorized Official First Name:
ELISA
Authorized Official Middle Name:
B
Authorized Official Title or Position:
MEDICAL TECHNOLOGIST
Authorized Official Telephone Number:
787-655-7755

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  1233 , 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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