Provider Demographics
NPI:1407157704
Name:LABORATORY MEDICINE SERVICES INCORPORATED
Entity Type:Organization
Organization Name:LABORATORY MEDICINE SERVICES INCORPORATED
Other - Org Name:LABORATORIO CLINICO FLAMBOYAN
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBORA
Authorized Official - Middle Name:
Authorized Official - Last Name:LIMARDO-DEFENDINI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-306-3985
Mailing Address - Street 1:1353 LUIS VIGOREAUX
Mailing Address - Street 2:PMB 646
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966
Mailing Address - Country:US
Mailing Address - Phone:787-306-3985
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA 172 KM 7.5
Practice Address - Street 2:BO. BAYAMON SECTOR CERTENEJAS
Practice Address - City:CIDRA
Practice Address - State:PR
Practice Address - Zip Code:00739
Practice Address - Country:US
Practice Address - Phone:787-306-3985
Practice Address - Fax:787-708-2345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-03
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1227291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
40D2006469OtherCLIA
PR1227OtherPR LICENSE