Provider Demographics
NPI:1275778623
Name:LABORATORIO CLINICO EDMARIE
Entity Type:Organization
Organization Name:LABORATORIO CLINICO EDMARIE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDMARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DE LEON DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-361-0961
Mailing Address - Street 1:ZIRCONIA #105 LOS PRADOS SUR
Mailing Address - Street 2:
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646
Mailing Address - Country:US
Mailing Address - Phone:787-869-9500
Mailing Address - Fax:787-869-5656
Practice Address - Street 1:CARR.164 KM 7.7 BO. ACHIOTE
Practice Address - Street 2:CENTRO COMERCIAL JARDINES DE NARANJITO
Practice Address - City:NARANJITO
Practice Address - State:PR
Practice Address - Zip Code:00719
Practice Address - Country:US
Practice Address - Phone:787-869-9500
Practice Address - Fax:787-869-5656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-12
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1174291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory