Provider Demographics
NPI:1366452138
Name:LABORATORIO CLINICO HATO REY INC.
Entity Type:Organization
Organization Name:LABORATORIO CLINICO HATO REY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR AND OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NORMA
Authorized Official - Middle Name:IRIS
Authorized Official - Last Name:COLON
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-751-0874
Mailing Address - Street 1:5 CALLE FERNANDEZ
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918
Mailing Address - Country:US
Mailing Address - Phone:787-751-0874
Mailing Address - Fax:787-751-6300
Practice Address - Street 1:5 CALLE JOSE FERNANDEZ
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-751-0874
Practice Address - Fax:787-751-6300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR43291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
31418Medicare ID - Type Unspecified