Provider Demographics
NPI:1346545175
Name:LABORATORIO CLINICO PASEO DEL SUR INC
Entity Type:Organization
Organization Name:LABORATORIO CLINICO PASEO DEL SUR INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:ESTHER
Authorized Official - Last Name:COLON
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-505-9195
Mailing Address - Street 1:QINTAS DE MONSERRATE EL GRECO C1
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00730-1706
Mailing Address - Country:US
Mailing Address - Phone:787-505-9195
Mailing Address - Fax:
Practice Address - Street 1:CENTRO COMERCIAL PASEO DEL SUR PLAZA, SUITE C
Practice Address - Street 2:BARRIO VALLAS TORRES 291 AVE. LOS CAOBOS
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00731
Practice Address - Country:US
Practice Address - Phone:787-505-9195
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-26
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory