Provider Demographics
NPI:1184673840
Name:LABORATORIO CLINICO GINARA INC
Entity Type:Organization
Organization Name:LABORATORIO CLINICO GINARA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANWAR
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAFAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-750-5276
Mailing Address - Street 1:ROUND HILL 322 CRUZ DE MALTA
Mailing Address - Street 2:
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976
Mailing Address - Country:US
Mailing Address - Phone:787-750-5276
Mailing Address - Fax:787-750-5351
Practice Address - Street 1:SAN MARTIN 1253 JUAN BAIZ
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924-4301
Practice Address - Country:US
Practice Address - Phone:787-750-5276
Practice Address - Fax:787-750-5351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1105291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0031516Medicare PIN