Provider Demographics
NPI:1346239654
Name:EMPRESAS JERICO INC.
Entity Type:Organization
Organization Name:EMPRESAS JERICO INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MERCADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-851-1007
Mailing Address - Street 1:30 CALLE SALVADOR BRAU
Mailing Address - Street 2:
Mailing Address - City:CABO ROJO
Mailing Address - State:PR
Mailing Address - Zip Code:00623-3417
Mailing Address - Country:US
Mailing Address - Phone:787-851-1007
Mailing Address - Fax:787-255-2680
Practice Address - Street 1:30 CALLE SALVADOR BRAU
Practice Address - Street 2:
Practice Address - City:CABO ROJO
Practice Address - State:PR
Practice Address - Zip Code:00623-3417
Practice Address - Country:US
Practice Address - Phone:787-851-1007
Practice Address - Fax:787-255-2680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-19
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR488291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA-0202OtherPALIC
2176-3OtherASOCIACION DE MAESTROS
6230005OtherHUMANA
30433-JEOtherTRIPPLE-S
050680OtherCRUZ AZUL
0867636OtherCIGNA
400427OtherUTI
488OtherSERVICIOS DE SALUD BELLA
050680OtherCRUZ AZUL