Provider Demographics
NPI:1659336238
Name:LABORATORIO CLINICO FAMILIAR INC.
Entity Type:Organization
Organization Name:LABORATORIO CLINICO FAMILIAR INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:MUAY CHIING
Authorized Official - Middle Name:SANG
Authorized Official - Last Name:PONS-CHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-273-0335
Mailing Address - Street 1:862 AVE SAN PATRICIO
Mailing Address - Street 2:LAS LOMAS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00921-1308
Mailing Address - Country:US
Mailing Address - Phone:787-273-0335
Mailing Address - Fax:787-793-6538
Practice Address - Street 1:862 AVE SAN PATRICIO
Practice Address - Street 2:LAS LOMAS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-1308
Practice Address - Country:US
Practice Address - Phone:787-273-0335
Practice Address - Fax:787-793-6538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR732291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR800029OtherMMM PROVIDER NUMBER
PR30816OtherSSS PROVIDER NUMBER
PR30816OtherSSS PROVIDER NUMBER