Provider Demographics
NPI:1598874315
Name:LABORATORIO CLINICO BORINQUEN-SAN FRANCISCO
Entity Type:Organization
Organization Name:LABORATORIO CLINICO BORINQUEN-SAN FRANCISCO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:WHITLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-744-0330
Mailing Address - Street 1:2 CALLE BALDORIOTY
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-2606
Mailing Address - Country:US
Mailing Address - Phone:787-744-0330
Mailing Address - Fax:
Practice Address - Street 1:201 AVE DE DIEGO
Practice Address - Street 2:OFICINA 6
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00927-5815
Practice Address - Country:US
Practice Address - Phone:787-773-6338
Practice Address - Fax:787-763-3545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR664291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR664OtherLICENSE