Provider Demographics
NPI:1093102485
Name:LABORATORIO CLINICO PLAZA PALACIOS
Entity Type:Organization
Organization Name:LABORATORIO CLINICO PLAZA PALACIOS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NIXZALIZ
Authorized Official - Middle Name:
Authorized Official - Last Name:MARRERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-605-8827
Mailing Address - Street 1:615 CARR 152 SUITE 4
Mailing Address - Street 2:
Mailing Address - City:NARANJITO
Mailing Address - State:PR
Mailing Address - Zip Code:00719
Mailing Address - Country:US
Mailing Address - Phone:787-605-8827
Mailing Address - Fax:787-869-7181
Practice Address - Street 1:AVE LOS PALACIOS INTERSECCION CARR 167
Practice Address - Street 2:CENTRO COMERCIAL PLAZA PALACIOS LOCAL E-2
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953
Practice Address - Country:US
Practice Address - Phone:787-605-8827
Practice Address - Fax:787-869-9988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-23
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory