Provider Demographics
NPI:1609815422
Name:LABORATORIO CLINICO CARIBE
Entity Type:Organization
Organization Name:LABORATORIO CLINICO CARIBE
Other - Org Name:LABORATORIO CLINICO SAN FERNANDO
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVILA
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-798-3176
Mailing Address - Street 1:A31 CALLE 1
Mailing Address - Street 2:EXT VILLA RICA
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959-5019
Mailing Address - Country:US
Mailing Address - Phone:787-798-3176
Mailing Address - Fax:787-288-0774
Practice Address - Street 1:36 CALLE BARCELO
Practice Address - Street 2:ESQUINA PALMER
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953-2465
Practice Address - Country:US
Practice Address - Phone:787-870-2467
Practice Address - Fax:787-870-0376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR38238Medicare ID - Type Unspecified
PR0030977Medicare UPIN