Provider Demographics
NPI:1639310402
Name:LABORATORIO CLINICO CENTRAL
Entity Type:Organization
Organization Name:LABORATORIO CLINICO CENTRAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:GLADYSBEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DORTA
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-894-1145
Mailing Address - Street 1:5 CALLE T JORDAN CORREA
Mailing Address - Street 2:
Mailing Address - City:UTUADO
Mailing Address - State:PR
Mailing Address - Zip Code:00641-2880
Mailing Address - Country:US
Mailing Address - Phone:787-894-1145
Mailing Address - Fax:787-894-1145
Practice Address - Street 1:5 CALLE T JORDAN CORREA
Practice Address - Street 2:
Practice Address - City:UTUADO
Practice Address - State:PR
Practice Address - Zip Code:00641-2880
Practice Address - Country:US
Practice Address - Phone:787-894-1145
Practice Address - Fax:787-894-1145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-09
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR573291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory