Provider Demographics
NPI:1063842995
Name:CLINICAL LABORATORY SERVICES OF QUEBRADILLAS, INC
Entity Type:Organization
Organization Name:CLINICAL LABORATORY SERVICES OF QUEBRADILLAS, INC
Other - Org Name:LABORATORIO CLINICO MONROIG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ELLIOT
Authorized Official - Middle Name:
Authorized Official - Last Name:MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:APA
Authorized Official - Phone:787-432-1376
Mailing Address - Street 1:PO BOX 2387
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-2387
Mailing Address - Country:US
Mailing Address - Phone:787-895-3076
Mailing Address - Fax:787-895-3076
Practice Address - Street 1:CALLE FRANCISCO AVILA
Practice Address - Street 2:113
Practice Address - City:QUEBRADILLAS
Practice Address - State:PR
Practice Address - Zip Code:00678
Practice Address - Country:US
Practice Address - Phone:787-895-3076
Practice Address - Fax:787-895-3076
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
PR561291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory