Provider Demographics
NPI:1063505691
Name:LABORATORIO CLINICO DEL NORTE INC.
Entity Type:Organization
Organization Name:LABORATORIO CLINICO DEL NORTE INC.
Other - Org Name:LABORATORIO CLINICO BARCELONETA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARGARITA
Authorized Official - Middle Name:
Authorized Official - Last Name:GUTIERREZ
Authorized Official - Suffix:
Authorized Official - Credentials:BSMT
Authorized Official - Phone:787-846-6210
Mailing Address - Street 1:PO BOX 2095
Mailing Address - Street 2:
Mailing Address - City:BARCELONETA
Mailing Address - State:PR
Mailing Address - Zip Code:00617
Mailing Address - Country:US
Mailing Address - Phone:787-846-3210
Mailing Address - Fax:787-846-6210
Practice Address - Street 1:AVE. PALMAS #22
Practice Address - Street 2:
Practice Address - City:BARCELONETA
Practice Address - State:PR
Practice Address - Zip Code:00617
Practice Address - Country:US
Practice Address - Phone:787-846-6210
Practice Address - Fax:787-846-6210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRLICENCE # 448291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRLICENCE # 448OtherDPT. OF HEALTH LICENCE #
PR40D0670708OtherCLIA CMS CERTIFICATE #