Provider Demographics
NPI:1154327401
Name:LAB CARIBE PONCE INC
Entity Type:Organization
Organization Name:LAB CARIBE PONCE INC
Other - Org Name:LABORATORIO CLINICO DEL CARIBE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:YAMILET
Authorized Official - Middle Name:SAMPOLL
Authorized Official - Last Name:RAMIREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-842-1116
Mailing Address - Street 1:1575 AVE MUNOZ RIVERA
Mailing Address - Street 2:PMB 133
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-0211
Mailing Address - Country:US
Mailing Address - Phone:787-842-1116
Mailing Address - Fax:787-842-1116
Practice Address - Street 1:CALLE FERROCARRIL # 617
Practice Address - Street 2:OFFICE 101
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1195
Practice Address - Country:US
Practice Address - Phone:787-842-1116
Practice Address - Fax:787-842-1116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-22
Last Update Date:2014-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR89291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRX21144Medicare UPIN
PR0031162Medicare PIN