Provider Demographics
NPI:1164466306
Name:LABORATORIO CLINICO LOPEZ LLC
Entity Type:Organization
Organization Name:LABORATORIO CLINICO LOPEZ LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DUENA
Authorized Official - Prefix:
Authorized Official - First Name:EDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-898-6032
Mailing Address - Street 1:111 AVE MUNOZ RIVERA W
Mailing Address - Street 2:
Mailing Address - City:CAMUY
Mailing Address - State:PR
Mailing Address - Zip Code:00627-2649
Mailing Address - Country:US
Mailing Address - Phone:787-898-0814
Mailing Address - Fax:787-898-6032
Practice Address - Street 1:111 AVE MUNOZ RIVERA W
Practice Address - Street 2:
Practice Address - City:CAMUY
Practice Address - State:PR
Practice Address - Zip Code:00627-2649
Practice Address - Country:US
Practice Address - Phone:787-898-0814
Practice Address - Fax:787-898-6032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR611291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory