Provider Demographics
NPI:1598802845
Name:LABORATORIO CLINICO VEGA ALTA
Entity Type:Organization
Organization Name:LABORATORIO CLINICO VEGA ALTA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:A
Authorized Official - Last Name:CANCEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-883-3765
Mailing Address - Street 1:54 CALLE COLON
Mailing Address - Street 2:
Mailing Address - City:VEGA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00692-7074
Mailing Address - Country:US
Mailing Address - Phone:787-883-3765
Mailing Address - Fax:787-270-2337
Practice Address - Street 1:54 CALLE COLON
Practice Address - Street 2:
Practice Address - City:VEGA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00692-7074
Practice Address - Country:US
Practice Address - Phone:787-883-3765
Practice Address - Fax:787-270-2337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR458291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory