Provider Demographics
NPI:1235249954
Name:LABORATORIO CLINICO DEL PUEBLO INC
Entity Type:Organization
Organization Name:LABORATORIO CLINICO DEL PUEBLO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LIPTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-720-4120
Mailing Address - Street 1:96 CALLE CARAZO
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969
Mailing Address - Country:US
Mailing Address - Phone:787-720-4140
Mailing Address - Fax:787-720-0101
Practice Address - Street 1:96 CALLE CARAZO
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969
Practice Address - Country:US
Practice Address - Phone:787-720-4140
Practice Address - Fax:787-720-0101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR682291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR038222400Medicaid
PR40D0658100OtherCLIA
PR0038280Medicare PIN