Provider Demographics
NPI:1689838732
Name:LABORATORIO CLINICO CHEGAR INC
Entity Type:Organization
Organization Name:LABORATORIO CLINICO CHEGAR INC
Other - Org Name:LABORATORIO CLINICO DEL CDT CANOVANAS
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTORA
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:CEPEDA
Authorized Official - Suffix:
Authorized Official - Credentials:BS,MT,ASCP
Authorized Official - Phone:787-809-4697
Mailing Address - Street 1:PO BOX 1631
Mailing Address - Street 2:
Mailing Address - City:CANOVANAS
Mailing Address - State:PR
Mailing Address - Zip Code:00729-1631
Mailing Address - Country:US
Mailing Address - Phone:787-886-3659
Mailing Address - Fax:787-886-3659
Practice Address - Street 1:CALLE CORCHADO FINAL 1
Practice Address - Street 2:PUEBLO
Practice Address - City:CANOVANAS
Practice Address - State:PR
Practice Address - Zip Code:00729-1631
Practice Address - Country:US
Practice Address - Phone:787-886-3659
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-17
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR00961291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0031548Medicare PIN