Provider Demographics
NPI:1073760641
Name:LABORATORIO CLINICO CAGUAS NORTE
Entity Type:Organization
Organization Name:LABORATORIO CLINICO CAGUAS NORTE
Other - Org Name:ANGELO MENDEZ
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELO
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDEZ
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:787-746-1665
Mailing Address - Street 1:PO BOX 8323
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726
Mailing Address - Country:US
Mailing Address - Phone:787-746-1665
Mailing Address - Fax:787-746-1665
Practice Address - Street 1:URB PARADIS CALLE LOPEZ FLORES ESQ MUNOZ RIVERA
Practice Address - Street 2:SUITE 3
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-746-1665
Practice Address - Fax:787-746-1665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-26
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR78291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRCLIA IDOther40D0658327