Provider Demographics
NPI:1063842904
Name:LABORATORIO CLINICO BOQUERON INC,
Entity Type:Organization
Organization Name:LABORATORIO CLINICO BOQUERON INC,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:DE LOS A
Authorized Official - Last Name:OCASIO
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-254-2550
Mailing Address - Street 1:PO BOX 323
Mailing Address - Street 2:
Mailing Address - City:BOQUERON
Mailing Address - State:PR
Mailing Address - Zip Code:00622-0323
Mailing Address - Country:US
Mailing Address - Phone:787-254-2550
Mailing Address - Fax:787-254-2550
Practice Address - Street 1:63 CALLE LUIS MUNOZ RIVERA
Practice Address - Street 2:
Practice Address - City:BOQUERON
Practice Address - State:PR
Practice Address - Zip Code:00622
Practice Address - Country:US
Practice Address - Phone:787-254-2550
Practice Address - Fax:787-254-2550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-13
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR803291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRH0831AOtherMEDICARE PTAN