Provider Demographics
NPI:1114464229
Name:LABORATORIO CLINICO LOS PUERTOS INC.
Entity Type:Organization
Organization Name:LABORATORIO CLINICO LOS PUERTOS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENT AGENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEXADRA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-466-8478
Mailing Address - Street 1:DB15 CALLE LAGO PATILLAS
Mailing Address - Street 2:URB LEVITTOWN
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949
Mailing Address - Country:US
Mailing Address - Phone:787-466-8478
Mailing Address - Fax:
Practice Address - Street 1:67 CARR 691 COMM LOS PUERTOS
Practice Address - Street 2:BO HIGULLAR
Practice Address - City:DORADO
Practice Address - State:PR
Practice Address - Zip Code:00646
Practice Address - Country:US
Practice Address - Phone:787-466-8478
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-26
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory