Provider Demographics
NPI:1508040718
Name:LABORATORIO CLINICO PENUELAS
Entity Type:Organization
Organization Name:LABORATORIO CLINICO PENUELAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:E
Authorized Official - Last Name:CALIZ-LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MT ASCP
Authorized Official - Phone:787-836-1660
Mailing Address - Street 1:315 CALLE MUNOZ RIVERA
Mailing Address - Street 2:
Mailing Address - City:PENUELAS
Mailing Address - State:PR
Mailing Address - Zip Code:00624-2009
Mailing Address - Country:US
Mailing Address - Phone:787-836-1660
Mailing Address - Fax:787-836-1660
Practice Address - Street 1:315 CALLE MUNOZ RIVERA
Practice Address - Street 2:
Practice Address - City:PENUELAS
Practice Address - State:PR
Practice Address - Zip Code:00624-2009
Practice Address - Country:US
Practice Address - Phone:787-836-1660
Practice Address - Fax:787-836-1660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-24
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory