Provider Demographics
NPI:1346367273
Name:LABORATORIO CLINICO APOLO
Entity Type:Organization
Organization Name:LABORATORIO CLINICO APOLO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL TECHNOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:JERUSHA
Authorized Official - Middle Name:
Authorized Official - Last Name:ARBOLEDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-789-5836
Mailing Address - Street 1:C2 AVE ALEJANDRINO
Mailing Address - Street 2:VILLA CLEMENTINA
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-4704
Mailing Address - Country:US
Mailing Address - Phone:787-789-5836
Mailing Address - Fax:
Practice Address - Street 1:C2 AVE ALEJANDRINO
Practice Address - Street 2:VILLA CLEMENTINA
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-4704
Practice Address - Country:US
Practice Address - Phone:787-789-5836
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-24
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR222291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR30127OtherTRIPLE-S
PR222OtherSTATE LICENSE
PR0030127Medicare ID - Type UnspecifiedMEDICARE