Provider Demographics
NPI:1619151487
Name:LABORATORIO CLINICO OCEAN BLUE, INC.
Entity Type:Organization
Organization Name:LABORATORIO CLINICO OCEAN BLUE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:URIEL
Authorized Official - Last Name:PAGAN OQUENDO
Authorized Official - Suffix:
Authorized Official - Credentials:MT (ASCP)
Authorized Official - Phone:787-410-9719
Mailing Address - Street 1:URB GRAND PALM II
Mailing Address - Street 2:242 CALLE ALMENDRO
Mailing Address - City:VEGA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00692-0000
Mailing Address - Country:US
Mailing Address - Phone:787-410-9719
Mailing Address - Fax:
Practice Address - Street 1:BO. MEDIANIA ALTA CARR 187 KM. 22.7
Practice Address - Street 2:
Practice Address - City:LOIZA
Practice Address - State:PR
Practice Address - Zip Code:00772
Practice Address - Country:US
Practice Address - Phone:787-876-1694
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-28
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1146291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory