Provider Demographics
NPI:1558507590
Name:LABORATORIO CLINICO PORTA DEL SOL, P.S.C.
Entity Type:Organization
Organization Name:LABORATORIO CLINICO PORTA DEL SOL, P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL TECHNOLOGIST/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MAX
Authorized Official - Middle Name:ORLANDO
Authorized Official - Last Name:NIEVES-NIEVES
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-252-3167
Mailing Address - Street 1:HC 60 BOX 29241-11
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602-9233
Mailing Address - Country:US
Mailing Address - Phone:787-252-3167
Mailing Address - Fax:787-252-3167
Practice Address - Street 1:BO. GUAYABO CARRETERA PR-115 KM 20.5
Practice Address - Street 2:
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602-9739
Practice Address - Country:US
Practice Address - Phone:787-252-3167
Practice Address - Fax:787-252-3167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-22
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1190291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory