Provider Demographics
NPI:1154498350
Name:LABORATORIO CLINICO LOMAR INC.
Entity Type:Organization
Organization Name:LABORATORIO CLINICO LOMAR INC.
Other - Org Name:LABORATORIO CLINICO LOMAR ,INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:LARACUENTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-867-2907
Mailing Address - Street 1:CALLE PEDRO ARROYO #4
Mailing Address - Street 2:
Mailing Address - City:OROCOVIS
Mailing Address - State:PR
Mailing Address - Zip Code:00720
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:CALLE PEDRO ARROYO #4
Practice Address - Street 2:
Practice Address - City:OROCOVIS
Practice Address - State:PR
Practice Address - Zip Code:00720
Practice Address - Country:US
Practice Address - Phone:787-867-2907
Practice Address - Fax:787-867-2907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR725291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
800184OtherMMM
30620OtherSSS
20225COtherPREFERRED MEDICAL CHOICE
800184OtherMMM
=========02Medicare UPIN
800184OtherMMM
=========2Medicare ID - Type Unspecified