Provider Demographics
NPI:1609247881
Name:LABORATORIO NEOCLINICO INC.
Entity Type:Organization
Organization Name:LABORATORIO NEOCLINICO INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DARLING
Authorized Official - Middle Name:TAIZ
Authorized Official - Last Name:PANTOJA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-669-6226
Mailing Address - Street 1:PO BOX 4002
Mailing Address - Street 2:PMB 164
Mailing Address - City:VEGA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00692
Mailing Address - Country:US
Mailing Address - Phone:787-306-1900
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA 2 KM 18.4
Practice Address - Street 2:
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949
Practice Address - Country:US
Practice Address - Phone:787-306-1900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-13
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15-120291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR15-120OtherCNC CERTIFICADO DE NECESIDAD Y CONVENIENCIA, DEPARTAMENTO DE SALUD