Provider Demographics
NPI:1073879425
Name:LABORATORIO CLINICO TIAGO INC.
Entity Type:Organization
Organization Name:LABORATORIO CLINICO TIAGO INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LIZBETH
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-859-1823
Mailing Address - Street 1:RR 2 BOX 5634
Mailing Address - Street 2:
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953-8956
Mailing Address - Country:US
Mailing Address - Phone:787-859-1823
Mailing Address - Fax:787-859-1823
Practice Address - Street 1:URB. SAN FELIZ
Practice Address - Street 2:CALLE 1 NUM A-2
Practice Address - City:COROZAL
Practice Address - State:PR
Practice Address - Zip Code:00783
Practice Address - Country:US
Practice Address - Phone:787-859-1823
Practice Address - Fax:787-859-1823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-10
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1253291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory