Provider Demographics
NPI:1659339661
Name:LABORATORIO CLINICO CAMPO RICO ,INC.
Entity Type:Organization
Organization Name:LABORATORIO CLINICO CAMPO RICO ,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ADA
Authorized Official - Middle Name:E
Authorized Official - Last Name:QUINONES
Authorized Official - Suffix:
Authorized Official - Credentials:MEDICAL TECHNOLOGIST
Authorized Official - Phone:787-762-0655
Mailing Address - Street 1:929 AVE ROBERTO SANCHEZ VILELLA
Mailing Address - Street 2:COUNTRY CLUB
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00924-2585
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:787-276-0677
Practice Address - Street 1:929 ROBERT O SANCHEZ VILELLA AVE.
Practice Address - Street 2:COUNTRY CLUB
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924-2585
Practice Address - Country:US
Practice Address - Phone:787-762-0655
Practice Address - Fax:787-276-0677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR786291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0038339Medicare ID - Type UnspecifiedLABORATORIO CAMPO RICO