Provider Demographics
NPI:1083619019
Name:LABORATORIO CLINICO LA 100 INC
Entity Type:Organization
Organization Name:LABORATORIO CLINICO LA 100 INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ARACELYS
Authorized Official - Middle Name:
Authorized Official - Last Name:MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-255-0100
Mailing Address - Street 1:2301 CARR 100
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CABO ROJO
Mailing Address - State:PR
Mailing Address - Zip Code:00623-4445
Mailing Address - Country:US
Mailing Address - Phone:787-255-0100
Mailing Address - Fax:787-851-0100
Practice Address - Street 1:2301 CARR 100
Practice Address - Street 2:SUITE 103
Practice Address - City:CABO ROJO
Practice Address - State:PR
Practice Address - Zip Code:00623-4445
Practice Address - Country:US
Practice Address - Phone:787-255-0100
Practice Address - Fax:787-851-0100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-16
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1044291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR31233Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER