Provider Demographics
NPI:1164696134
Name:LABORATORIO CLINICO EL SHADDAI,INC.
Entity Type:Organization
Organization Name:LABORATORIO CLINICO EL SHADDAI,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL TECHNOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:S
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-249-5350
Mailing Address - Street 1:PO BOX 5005
Mailing Address - Street 2:PMB 23
Mailing Address - City:SAN LORENZO
Mailing Address - State:PR
Mailing Address - Zip Code:00754-5005
Mailing Address - Country:US
Mailing Address - Phone:787-249-5350
Mailing Address - Fax:787-736-8838
Practice Address - Street 1:CARR 183 # KM7.7
Practice Address - Street 2:BO. HATO
Practice Address - City:SAN LORENZO
Practice Address - State:PR
Practice Address - Zip Code:00754-4530
Practice Address - Country:US
Practice Address - Phone:787-249-5350
Practice Address - Fax:787-736-8838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-21
Last Update Date:2008-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1148291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory