Provider Demographics
NPI:1275817561
Name:CITY LAB INC
Entity Type:Organization
Organization Name:CITY LAB INC
Other - Org Name:LABORATORIO CLINICO CITY LAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:COLON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:787-750-7923
Mailing Address - Street 1:239 ARTERIAL HOSTOS
Mailing Address - Street 2:SUITE 303
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-1475
Mailing Address - Country:US
Mailing Address - Phone:787-750-7923
Mailing Address - Fax:787-281-0393
Practice Address - Street 1:AVE 65TH INFANTERIA CENTRO COMERCIAL PLAZA ITURREGUI
Practice Address - Street 2:# 10
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924
Practice Address - Country:US
Practice Address - Phone:787-750-7923
Practice Address - Fax:787-281-0393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-05
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1241291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC40D2024597OtherCLIA