Provider Demographics
NPI:1558415265
Name:LABORATORIO PULMONAR CAROLINA INC
Entity Type:Organization
Organization Name:LABORATORIO PULMONAR CAROLINA INC
Other - Org Name:LABORATORIO PULMONAR ASHFORD
Other - Org Type:Other Name
Authorized Official - Title/Position:BOARD DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:YOHANA
Authorized Official - Middle Name:
Authorized Official - Last Name:DE JESUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-276-1195
Mailing Address - Street 1:PO BOX 9670
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00988-9670
Mailing Address - Country:US
Mailing Address - Phone:787-276-1195
Mailing Address - Fax:
Practice Address - Street 1:4ES5 VILLA FONTANA
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00983
Practice Address - Country:US
Practice Address - Phone:787-276-1195
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7402207RP1001X
261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Not Answered261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR82443Medicare ID - Type Unspecified