1780988659 NPI number — LABORATORIO CLINICO MINILLAS CORP.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780988659 NPI number — LABORATORIO CLINICO MINILLAS CORP.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LABORATORIO CLINICO MINILLAS CORP.
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:
1780988659
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/15/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
NH31 CAMINO DE VELARDE
Provider Second Line Business Mailing Address:
MANSION DEL NORTE
Provider Business Mailing Address City Name:
TOA BAJA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00949-4839
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-784-7897
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
MINILLAS CT
Provider Second Line Business Practice Location Address:
NM 14 SANTA JUANITA
Provider Business Practice Location Address City Name:
BAYAMON
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00956-5359
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-269-5262
Provider Business Practice Location Address Fax Number:
787-798-3853
Provider Enumeration Date:
01/06/2011

Additional Information

Authorized Official

Authorized Official Last Name:
ROMAN
Authorized Official First Name:
WANDA
Authorized Official Middle Name:
IVELISSE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-941-7264

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  1260 , 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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