Provider Demographics
NPI:1417926189
Name:LABORATORIO CLINICO FAGOT, INC.
Entity Type:Organization
Organization Name:LABORATORIO CLINICO FAGOT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL TECHNOLOGIST/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOHANNA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:BSMT
Authorized Official - Phone:787-843-7555
Mailing Address - Street 1:2929 AVE EMILIO FAGOT
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-3613
Mailing Address - Country:US
Mailing Address - Phone:787-843-7555
Mailing Address - Fax:787-290-0621
Practice Address - Street 1:2929 AVE EMILIO FAGOT
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-3613
Practice Address - Country:US
Practice Address - Phone:787-843-7555
Practice Address - Fax:787-290-0621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR621291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory