Provider Demographics
NPI:1144224825
Name:EDNA L NEGRON WEBER ESTATE
Entity Type:Organization
Organization Name:EDNA L NEGRON WEBER ESTATE
Other - Org Name:LABORATORIO CLINICO NEGRON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REPRESENTATIVE EDNA L NEGRON WEBER
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:LETICIA
Authorized Official - Last Name:RAMOS NEGRON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-873-6976
Mailing Address - Street 1:PO BOX 429
Mailing Address - Street 2:
Mailing Address - City:SABANA GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00637-0429
Mailing Address - Country:US
Mailing Address - Phone:787-873-4710
Mailing Address - Fax:787-873-6976
Practice Address - Street 1:CALLE RODRIGUEZ SERRA 16
Practice Address - Street 2:
Practice Address - City:SABANA GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00637
Practice Address - Country:US
Practice Address - Phone:787-873-4710
Practice Address - Fax:787-873-6976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-09
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR257291U00000X
PR40D667290291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2136OtherIMC
PR20230OtherPMC
PR7470003OtherHUMANA
PR800345OtherMMM
PRB197OtherHEALTH PLAN IMC
PR7470003OtherHUMANA
PR800345OtherMMM