Provider Demographics
NPI:1689724866
Name:LABORATORIO CLINICO Y DE REF DE FAJARDO INC
Entity Type:Organization
Organization Name:LABORATORIO CLINICO Y DE REF DE FAJARDO INC
Other - Org Name:LABORATORIO DEL ESTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PATHOLOGIST (DIRECTOR)
Authorized Official - Prefix:DR
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-863-3000
Mailing Address - Street 1:GENERAL VALERO AVE 303
Mailing Address - Street 2:
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738
Mailing Address - Country:US
Mailing Address - Phone:787-863-3000
Mailing Address - Fax:787-860-5700
Practice Address - Street 1:GENERAL VALERO AVE 303
Practice Address - Street 2:
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738
Practice Address - Country:US
Practice Address - Phone:787-863-3000
Practice Address - Fax:787-860-5700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR670291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR38123Medicare ID - Type UnspecifiedPROVIDER NUMBER