Provider Demographics
NPI:1023000361
Name:LABORATORIO CLINICO TINTILLO
Entity Type:Organization
Organization Name:LABORATORIO CLINICO TINTILLO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARLEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:POU
Authorized Official - Suffix:
Authorized Official - Credentials:BS, MT
Authorized Official - Phone:787-783-5686
Mailing Address - Street 1:PO BOX 194690
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-4690
Mailing Address - Country:US
Mailing Address - Phone:787-783-5686
Mailing Address - Fax:787-707-0818
Practice Address - Street 1:12 CALLE BUEN SAMARITANO
Practice Address - Street 2:JUAN DOMINGO
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00966-7934
Practice Address - Country:US
Practice Address - Phone:787-783-5686
Practice Address - Fax:787-707-0818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-22
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR552291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0030506Medicare PIN