Provider Demographics
NPI:1639893175
Name:PONCE CLINICAL LABORATORY, INC.
Entity Type:Organization
Organization Name:PONCE CLINICAL LABORATORY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GRYCEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSADO
Authorized Official - Suffix:
Authorized Official - Credentials:LCDA
Authorized Official - Phone:787-841-4846
Mailing Address - Street 1:609 AVE TITO CASTRO STE 101
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-0206
Mailing Address - Country:US
Mailing Address - Phone:939-630-2689
Mailing Address - Fax:
Practice Address - Street 1:1128 AVE MUNOZ RIVERA
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-0643
Practice Address - Country:US
Practice Address - Phone:787-848-0405
Practice Address - Fax:787-290-3535
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PONCE CLINICAL LABORATORY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-09-28
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory