Provider Demographics
NPI:1376739110
Name:LABORATORIO FRONTERA
Entity Type:Organization
Organization Name:LABORATORIO FRONTERA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:JULIANA
Authorized Official - Middle Name:SOFIA
Authorized Official - Last Name:FRONTERA
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-832-2345
Mailing Address - Street 1:CALLE MENDEZ VIGO #110 E
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680
Mailing Address - Country:US
Mailing Address - Phone:787-458-8060
Mailing Address - Fax:787-832-2345
Practice Address - Street 1:110 CALLE MENDEZ VIGO E
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-5052
Practice Address - Country:US
Practice Address - Phone:787-832-2345
Practice Address - Fax:787-832-2345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-14
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR995291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory