Provider Demographics
NPI:1336135060
Name:LABORATORIO CLINICO MEDICO CAROLINA INC
Entity Type:Organization
Organization Name:LABORATORIO CLINICO MEDICO CAROLINA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:IVETTE
Authorized Official - Last Name:COLON
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-750-7005
Mailing Address - Street 1:PO BOX 8848
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00988-8848
Mailing Address - Country:US
Mailing Address - Phone:787-750-7005
Mailing Address - Fax:787-750-2779
Practice Address - Street 1:3FS6 AVENIDA FRAGOSO
Practice Address - Street 2:VILLA FONTANA
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00983-0983
Practice Address - Country:US
Practice Address - Phone:787-750-7005
Practice Address - Fax:787-750-2779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR547291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0038305Medicare ID - Type Unspecified