Provider Demographics
NPI:1114907094
Name:LABORATORIO CLINICO C L A INC
Entity Type:Organization
Organization Name:LABORATORIO CLINICO C L A INC
Other - Org Name:LAB CLINICO CLA INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:D
Authorized Official - Last Name:WHITLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-743-0330
Mailing Address - Street 1:2 CALLE BALDORIOTY
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-2606
Mailing Address - Country:US
Mailing Address - Phone:787-743-0330
Mailing Address - Fax:787-744-2588
Practice Address - Street 1:400 AVE FD ROOSEVELT
Practice Address - Street 2:SUITE 201
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-2103
Practice Address - Country:US
Practice Address - Phone:787-744-0330
Practice Address - Fax:787-744-2588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-18
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR757291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR38212OtherMEDICARE CMS
PR38212Medicare PIN