Provider Demographics
NPI:1316182603
Name:MUNICIPIO DE GUANICA
Entity Type:Organization
Organization Name:MUNICIPIO DE GUANICA
Other - Org Name:LABORATORIO CLINICO CENTRO DE SERVICIOS DE SALUD DE GUANICA
Other - Org Type:Other Name
Authorized Official - Title/Position:MAJOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:VARGAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-821-2777
Mailing Address - Street 1:PO BOX 785
Mailing Address - Street 2:
Mailing Address - City:GUANICA
Mailing Address - State:PR
Mailing Address - Zip Code:00653-0785
Mailing Address - Country:US
Mailing Address - Phone:787-821-0402
Mailing Address - Fax:787-821-0402
Practice Address - Street 1:CARR. 116 KM 27.7
Practice Address - Street 2:
Practice Address - City:GUANICA
Practice Address - State:PR
Practice Address - Zip Code:00653
Practice Address - Country:US
Practice Address - Phone:787-821-0402
Practice Address - Fax:787-821-0402
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MUNICIPIO DE GUANICA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-12-16
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1175291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1175OtherPUERTO RICO HEALTHCARE DEPARTMENT