1851370803 NPI number — NILLIAN L GUZMAN LABORATORIO CLINICO FAMILIAR

Table of content: (NPI 1851370803)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851370803 NPI number — NILLIAN L GUZMAN LABORATORIO CLINICO FAMILIAR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NILLIAN L GUZMAN LABORATORIO CLINICO FAMILIAR
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:
1851370803
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/16/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 358
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOCA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00676-0358
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-818-9028
Provider Business Mailing Address Fax Number:
787-818-9028

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
AVE LA MOCA 202 CARR 111 KM 4.6
Provider Second Line Business Practice Location Address:
SUITE 1 MOCA PROFESSIONAL CENTER
Provider Business Practice Location Address City Name:
MOCA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00676-0358
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-818-9028
Provider Business Practice Location Address Fax Number:
787-818-9028
Provider Enumeration Date:
01/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GUZMAN
Authorized Official First Name:
NILLIAN
Authorized Official Middle Name:
L
Authorized Official Title or Position:
LAB OWNER
Authorized Official Telephone Number:
787-818-9028

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: 30064 . This is a "MEDICARE PART B" identifier . This identifiers is of the category "OTHER".
  • Identifier: 584212329 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 584212329 . This is a "MCS" identifier . This identifiers is of the category "OTHER".




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