Provider Demographics
NPI:1538518212
Name:LABORATORIO CLINICO OCEAN FRONT INC.
Entity Type:Organization
Organization Name:LABORATORIO CLINICO OCEAN FRONT INC.
Other - Org Name:LABORATORIO CLINICO DEL MAR III
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NORDIA
Authorized Official - Middle Name:LISBEL
Authorized Official - Last Name:BERRIOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-390-0642
Mailing Address - Street 1:PO BOX 1685
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-1685
Mailing Address - Country:US
Mailing Address - Phone:787-807-0007
Mailing Address - Fax:787-807-0007
Practice Address - Street 1:CARR PR-686, KM. 9.5,
Practice Address - Street 2:BO YEGUADA
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00694
Practice Address - Country:US
Practice Address - Phone:787-807-0007
Practice Address - Fax:787-807-0007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-03
Last Update Date:2016-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1217291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory