Provider Demographics
NPI:1497864474
Name:FABRIEL HERMANOS CORPORATION
Entity Type:Organization
Organization Name:FABRIEL HERMANOS CORPORATION
Other - Org Name:LABORATORIO HERNANDEZ - LOPEZ
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL TECHNOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:LOURDES
Authorized Official - Middle Name:
Authorized Official - Last Name:CORDERO
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-878-2780
Mailing Address - Street 1:PO BOX 141376
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00614-1376
Mailing Address - Country:US
Mailing Address - Phone:787-878-2780
Mailing Address - Fax:787-878-2780
Practice Address - Street 1:172 RODRIGUEZ IRIZARRY
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-878-2780
Practice Address - Fax:787-878-2780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR205291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0031423OtherPTAN