Provider Demographics
NPI:1013185495
Name:ANGELA E FUMERO PANETO
Entity Type:Organization
Organization Name:ANGELA E FUMERO PANETO
Other - Org Name:LABORATORIO CLINICO PLAZA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:ENID
Authorized Official - Last Name:FUMERO
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-856-0580
Mailing Address - Street 1:49 CALLE MUNOZ RIVERA
Mailing Address - Street 2:
Mailing Address - City:YAUCO
Mailing Address - State:PR
Mailing Address - Zip Code:00698-3233
Mailing Address - Country:US
Mailing Address - Phone:787-856-0580
Mailing Address - Fax:787-856-0580
Practice Address - Street 1:49 CALLE MUNOZ RIVERA
Practice Address - Street 2:
Practice Address - City:YAUCO
Practice Address - State:PR
Practice Address - Zip Code:00698-3233
Practice Address - Country:US
Practice Address - Phone:787-856-0580
Practice Address - Fax:787-856-0580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-19
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR340291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0031228Medicare PIN