Provider Demographics
NPI:1306813605
Name:LABORATORIO CLINICO PLAZA INC
Entity Type:Organization
Organization Name:LABORATORIO CLINICO PLAZA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTA
Authorized Official - Prefix:MRS
Authorized Official - First Name:MILAGROS
Authorized Official - Middle Name:IVELISSE
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-787-7244
Mailing Address - Street 1:10-3 AVE AGUAS BUENAS
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959-6611
Mailing Address - Country:US
Mailing Address - Phone:787-787-7244
Mailing Address - Fax:787-780-0700
Practice Address - Street 1:PMB 423 1353 RD 19
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00966-2700
Practice Address - Country:US
Practice Address - Phone:787-787-7244
Practice Address - Fax:787-780-0700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-06
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR409291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR38191Medicare ID - Type Unspecified