Provider Demographics
NPI:1578719050
Name:LABORATORIO CLINICO COROZAL, INC.
Entity Type:Organization
Organization Name:LABORATORIO CLINICO COROZAL, INC.
Other - Org Name:LABORATORIO CLINICO COROZAL II
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:MILAGROS
Authorized Official - Middle Name:
Authorized Official - Last Name:DE JESUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-859-2465
Mailing Address - Street 1:PO BOX 900
Mailing Address - Street 2:
Mailing Address - City:COROZAL
Mailing Address - State:PR
Mailing Address - Zip Code:00783-0900
Mailing Address - Country:US
Mailing Address - Phone:787-859-2465
Mailing Address - Fax:787-859-8072
Practice Address - Street 1:ROAD 159 KM 15.3
Practice Address - Street 2:BO. PUEBLO
Practice Address - City:COROZAL
Practice Address - State:PR
Practice Address - Zip Code:00783
Practice Address - Country:US
Practice Address - Phone:787-859-2465
Practice Address - Fax:787-859-8072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-15
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1160291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory