Provider Demographics
NPI:1578619292
Name:LABORATORIO CLINICO JARDINES
Entity Type:Organization
Organization Name:LABORATORIO CLINICO JARDINES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LABORATORY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSANA
Authorized Official - Middle Name:
Authorized Official - Last Name:BERRIOS
Authorized Official - Suffix:
Authorized Official - Credentials:MEDICAL TECHNOLOGIST
Authorized Official - Phone:787-752-4010
Mailing Address - Street 1:PO BOX 3278
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00984-3278
Mailing Address - Country:US
Mailing Address - Phone:787-752-4010
Mailing Address - Fax:787-768-5818
Practice Address - Street 1:BE # 5 AVE GALICIA
Practice Address - Street 2:JDNES COUNTRY CLUB
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00983
Practice Address - Country:US
Practice Address - Phone:787-752-4010
Practice Address - Fax:787-768-5818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR685291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory