Provider Demographics
NPI:1467441782
Name:LABORATORIO CLINICO ANALITICO INC
Entity Type:Organization
Organization Name:LABORATORIO CLINICO ANALITICO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND LABORATORY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALMA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRASQUILLO
Authorized Official - Suffix:
Authorized Official - Credentials:ASCP
Authorized Official - Phone:787-290-4024
Mailing Address - Street 1:1326 CALLE SALUD
Mailing Address - Street 2:STE 309
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-1686
Mailing Address - Country:US
Mailing Address - Phone:787-290-4024
Mailing Address - Fax:787-842-5327
Practice Address - Street 1:1326 CALLE SALUD
Practice Address - Street 2:STE 309
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1686
Practice Address - Country:US
Practice Address - Phone:787-290-4024
Practice Address - Fax:787-842-5327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR437291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
30334OtherSSS
30334OtherSSS