Provider Demographics
NPI:1639162977
Name:CENTER DIAGNOSTIC LABORATORY,INC
Entity Type:Organization
Organization Name:CENTER DIAGNOSTIC LABORATORY,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:EMILIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BERRIOS
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-781-2016
Mailing Address - Street 1:1251 AVE AMERICO MIRANDA
Mailing Address - Street 2:REPARTO METROPOLITANO
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00921-1619
Mailing Address - Country:US
Mailing Address - Phone:787-781-2016
Mailing Address - Fax:
Practice Address - Street 1:1251 AVE AMERICO MIRANDA
Practice Address - Street 2:REPARTO METROPOLITANO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-1619
Practice Address - Country:US
Practice Address - Phone:787-781-2016
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR215291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR400048OtherPREFERRED HEALTH
PR051349OtherLA CRUZ AZUL DE PR
PR0023OtherPALIC
PR6933OtherFIRST MEDICAL
PR30608CEOtherTRIPLE S, INC
PR9210021OtherHUMANA
PR=========OtherMCS
PR=========OtherMAPFRE
PR0023OtherPALIC
PR051349OtherLA CRUZ AZUL DE PR
PR=========OtherMAPFRE