Provider Demographics
NPI:1508940263
Name:LABCA INC
Entity Type:Organization
Organization Name:LABCA INC
Other - Org Name:LABORATORIO CLINICO CANTERA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MIGDALIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARRERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-854-3920
Mailing Address - Street 1:1002 ROUTE 2 BO CANTERA
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674
Mailing Address - Country:US
Mailing Address - Phone:787-854-3920
Mailing Address - Fax:787-854-4713
Practice Address - Street 1:ROUTE 2 KM 44.6 BO CANTERA
Practice Address - Street 2:
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-854-3920
Practice Address - Fax:787-854-4713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1018291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
30856OtherSSS HEALTH PLAN
=========OtherMCS HEALTH PLAN
30856Medicare ID - Type Unspecified