Provider Demographics
NPI:1003107707
Name:LABORATORIO CLINICO DEL TOA
Entity Type:Organization
Organization Name:LABORATORIO CLINICO DEL TOA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ILIA
Authorized Official - Middle Name:
Authorized Official - Last Name:COLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-486-2768
Mailing Address - Street 1:PO BOX 505
Mailing Address - Street 2:
Mailing Address - City:VEGA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00692-0505
Mailing Address - Country:US
Mailing Address - Phone:787-486-2768
Mailing Address - Fax:
Practice Address - Street 1:LILLY MINI MALL CARR 165 KM 10.2 BO. CONTORNO
Practice Address - Street 2:
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00954-0000
Practice Address - Country:US
Practice Address - Phone:787-486-2768
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-28
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory