Provider Demographics
NPI:1366636425
Name:QUEST DIAGNOSTICS OF PUERTO RICO INC
Entity Type:Organization
Organization Name:QUEST DIAGNOSTICS OF PUERTO RICO INC
Other - Org Name:LABORATORIO CLINICO PAOLI CDT SUSANA CENTENO
Other - Org Type:Other Name
Authorized Official - Title/Position:VP NATIONAL BILLING
Authorized Official - Prefix:
Authorized Official - First Name:G
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:CARTIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-676-7000
Mailing Address - Street 1:881 AVE MUNOZ RIVERA
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00925-2117
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:ROAD 997 KM 1 HM 0
Practice Address - Street 2:CDT SUSANA CENTENO
Practice Address - City:VIEQUES
Practice Address - State:PR
Practice Address - Zip Code:00765
Practice Address - Country:US
Practice Address - Phone:787-741-9090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:QUEST DIAGNOSTICS INCORPORATED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-31
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory