Provider Demographics
NPI:1447428974
Name:LABORATORIO CLINICO GORDO
Entity Type:Organization
Organization Name:LABORATORIO CLINICO GORDO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LILLIAN
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:GORDO
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-720-3643
Mailing Address - Street 1:71 CALLE CARAZO
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-5700
Mailing Address - Country:US
Mailing Address - Phone:787-720-3643
Mailing Address - Fax:787-272-0833
Practice Address - Street 1:71 CALLE CARAZO
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-5700
Practice Address - Country:US
Practice Address - Phone:787-720-3643
Practice Address - Fax:787-272-0833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR105291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0031068Medicare PIN