Provider Demographics
NPI:1245211218
Name:LABORATORIO CLINICO DEL CENTRO
Entity Type:Organization
Organization Name:LABORATORIO CLINICO DEL CENTRO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LAB SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ILIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:TOLDEO
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-822-2414
Mailing Address - Street 1:53 RAMON TORRES ST
Mailing Address - Street 2:
Mailing Address - City:FLORIDA
Mailing Address - State:PR
Mailing Address - Zip Code:00650
Mailing Address - Country:US
Mailing Address - Phone:787-822-2414
Mailing Address - Fax:787-822-0779
Practice Address - Street 1:53 RAMON TORRES ST
Practice Address - Street 2:
Practice Address - City:FLORIDA
Practice Address - State:PR
Practice Address - Zip Code:00650
Practice Address - Country:US
Practice Address - Phone:787-822-2414
Practice Address - Fax:787-816-1309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR637291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR38301Medicare ID - Type Unspecified