Provider Demographics
NPI:1457330144
Name:LABORATORIO CLINICO ESMERALDA INC
Entity Type:Organization
Organization Name:LABORATORIO CLINICO ESMERALDA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:NELLY
Authorized Official - Middle Name:E
Authorized Official - Last Name:ACEVEDO
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-720-6943
Mailing Address - Street 1:207 AVE ESMERALDA
Mailing Address - Street 2:PONCE DE LEON
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-4448
Mailing Address - Country:US
Mailing Address - Phone:787-720-6943
Mailing Address - Fax:787-790-7060
Practice Address - Street 1:207 AVE ESMERALDA
Practice Address - Street 2:PONCE DE LEON
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-4448
Practice Address - Country:US
Practice Address - Phone:787-720-6943
Practice Address - Fax:787-790-7060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-11
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR386291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR30332OtherSSS PROVIDER NUMBER
PR30332OtherSSS PROVIDER NUMBER