Provider Demographics
NPI:1376603670
Name:NORINDA CACERES
Entity Type:Organization
Organization Name:NORINDA CACERES
Other - Org Name:LABORATORIO CLINICO MOCA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EMPLOYER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NORINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:CACERES
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-877-1900
Mailing Address - Street 1:PO BOX 576
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602-0576
Mailing Address - Country:US
Mailing Address - Phone:787-877-1900
Mailing Address - Fax:787-877-1900
Practice Address - Street 1:CALLE CONCEPCION VERA 90
Practice Address - Street 2:
Practice Address - City:MOCA
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00676
Practice Address - Country:UM
Practice Address - Phone:787-877-1900
Practice Address - Fax:787-877-1900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-10
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR843291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR31458Medicare ID - Type UnspecifiedCLINICAL LABORATORY