Provider Demographics
NPI:1679783146
Name:LABORATORIO CLINICA DE CUIDADO MEDICO INC
Entity Type:Organization
Organization Name:LABORATORIO CLINICA DE CUIDADO MEDICO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISORA
Authorized Official - Prefix:
Authorized Official - First Name:YESENIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DELGADO
Authorized Official - Suffix:
Authorized Official - Credentials:LIC
Authorized Official - Phone:787-871-1098
Mailing Address - Street 1:PO BOX 1347
Mailing Address - Street 2:
Mailing Address - City:CIALES
Mailing Address - State:PR
Mailing Address - Zip Code:00638-1347
Mailing Address - Country:US
Mailing Address - Phone:787-871-1098
Mailing Address - Fax:787-871-4883
Practice Address - Street 1:4 CALLE HOSPITAL
Practice Address - Street 2:
Practice Address - City:CIALES
Practice Address - State:PR
Practice Address - Zip Code:00638-3310
Practice Address - Country:US
Practice Address - Phone:787-871-1098
Practice Address - Fax:787-871-4883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1020291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1020OtherLICENCIA