Provider Demographics
NPI:1073942959
Name:LABORATORIO CLINICO EL TUQUE, INC
Entity Type:Organization
Organization Name:LABORATORIO CLINICO EL TUQUE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LILLY
Authorized Official - Middle Name:JADETTE
Authorized Official - Last Name:TORRES LUGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-259-1339
Mailing Address - Street 1:PARC EL TUQUE
Mailing Address - Street 2:523 CALLE RAMOS ANTONINI STE 1
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00728-4811
Mailing Address - Country:US
Mailing Address - Phone:787-259-1339
Mailing Address - Fax:787-259-1339
Practice Address - Street 1:PARC EL TUQUE
Practice Address - Street 2:523 CALLE RAMOS ANTONINI STE 1
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00728-4811
Practice Address - Country:US
Practice Address - Phone:787-259-1339
Practice Address - Fax:787-259-1339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-01
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR714291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory