Provider Demographics
NPI:1639135502
Name:LABORATORIO CLINICO PLAZA CAROLINA INC
Entity Type:Organization
Organization Name:LABORATORIO CLINICO PLAZA CAROLINA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY (OWNER)
Authorized Official - Prefix:MR
Authorized Official - First Name:EDGARDO
Authorized Official - Middle Name:GENARO
Authorized Official - Last Name:PINEIRO
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:787-616-7253
Mailing Address - Street 1:PO BOX 9741
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00988-9741
Mailing Address - Country:US
Mailing Address - Phone:787-768-0070
Mailing Address - Fax:787-768-0070
Practice Address - Street 1:AVE. FRAGOSO & EXPRESO LOIZA
Practice Address - Street 2:OFFICE #12 3ER NIVEL PLAZA CAROLINA MALL
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00988
Practice Address - Country:US
Practice Address - Phone:787-768-0070
Practice Address - Fax:787-768-0070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-21
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR871291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR800054OtherMMM
PR31099OtherSSS
PR31099Medicare ID - Type Unspecified