Provider Demographics
NPI:1679052161
Name:LABORATORIO CLINICO RENACER LLC
Entity Type:Organization
Organization Name:LABORATORIO CLINICO RENACER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAMARIS
Authorized Official - Middle Name:
Authorized Official - Last Name:CANDELARIO
Authorized Official - Suffix:
Authorized Official - Credentials:MLS
Authorized Official - Phone:787-236-8650
Mailing Address - Street 1:URB PALACIOS DEL MONTE
Mailing Address - Street 2:1603 CALLE RARIER
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953-5246
Mailing Address - Country:US
Mailing Address - Phone:787-236-8650
Mailing Address - Fax:
Practice Address - Street 1:IL 32 AVE CARLOS J ANDALUZ
Practice Address - Street 2:ROYAL PALM
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956
Practice Address - Country:US
Practice Address - Phone:787-626-9898
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-07
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory