Provider Demographics
NPI:1376526061
Name:LABORATORIO CLINICO EL PARAISO, INC.
Entity Type:Organization
Organization Name:LABORATORIO CLINICO EL PARAISO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LAB DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MOISES
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDEZ PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:ASCP; MT
Authorized Official - Phone:787-763-8573
Mailing Address - Street 1:URB EL CEREZAL 1648 CALLE PARANA STE 1
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-3145
Mailing Address - Country:US
Mailing Address - Phone:787-763-8573
Mailing Address - Fax:787-763-8573
Practice Address - Street 1:URB EL CEREZAL 1648 CALLE PARANA STE 1
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-3145
Practice Address - Country:US
Practice Address - Phone:787-763-8573
Practice Address - Fax:787-763-8573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-28
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR749291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR38249Medicare PIN