Provider Demographics
NPI:1316042195
Name:ENID HAYDEE ACEVEDO QUINONES
Entity Type:Organization
Organization Name:ENID HAYDEE ACEVEDO QUINONES
Other - Org Name:LABORATORIO CLINICO GENESIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ENID
Authorized Official - Middle Name:ACEVEDO
Authorized Official - Last Name:QUINONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-897-1636
Mailing Address - Street 1:PO BOX 1792
Mailing Address - Street 2:
Mailing Address - City:LARES
Mailing Address - State:PR
Mailing Address - Zip Code:00669-1792
Mailing Address - Country:US
Mailing Address - Phone:787-897-1636
Mailing Address - Fax:
Practice Address - Street 1:CARR 111 KM 4.2
Practice Address - Street 2:
Practice Address - City:LARES
Practice Address - State:PR
Practice Address - Zip Code:00669
Practice Address - Country:US
Practice Address - Phone:787-897-1636
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR892291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR800408OtherMMM
PRLA00612OtherPALIC
PR9996OtherINTERNATIONAL MEDICAL CAR
PR20024OtherPREFERRED MEDICARE CHOISE
PR6690047OtherHUMANA
PR100150OtherCRUZ AZUL
PR011892OtherGLOBAL HEALTH CARE
PR272535066OtherASOCIACION DE MAESTROS
PR31407OtherTRIPLE SSS, INC
PRLA00612OtherPALIC
PR011892OtherGLOBAL HEALTH CARE
PR100150OtherCRUZ AZUL
PR272535066OtherASOCIACION DE MAESTROS
PR=========OtherMEDICAL CARD SYSTEM