Provider Demographics
NPI:1568552610
Name:LABORATORIO CLINICO CHEGAR INC
Entity Type:Organization
Organization Name:LABORATORIO CLINICO CHEGAR INC
Other - Org Name:LAB CHEGAR 11
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTORA
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:CEPEDA
Authorized Official - Suffix:
Authorized Official - Credentials:BS,MT,ASCP
Authorized Official - Phone:787-809-4697
Mailing Address - Street 1:71 CALLE AUTONOMIA
Mailing Address - Street 2:
Mailing Address - City:CANOVANAS
Mailing Address - State:PR
Mailing Address - Zip Code:00729-3288
Mailing Address - Country:US
Mailing Address - Phone:787-256-6570
Mailing Address - Fax:787-876-4770
Practice Address - Street 1:71 CALLE AUTONOMIA
Practice Address - Street 2:
Practice Address - City:CANOVANAS
Practice Address - State:PR
Practice Address - Zip Code:00729
Practice Address - Country:US
Practice Address - Phone:787-256-6570
Practice Address - Fax:787-876-4770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR252291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0031015Medicare ID - Type UnspecifiedLABORATORIO CLINICO