Provider Demographics
NPI:1730281833
Name:GORDO, LABORATORIO CLINICO
Entity Type:Individual
Prefix:
First Name:LABORATORIO
Middle Name:CLINICO
Last Name:GORDO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LABORATORIO
Other - Middle Name:CLINICO
Other - Last Name:GORDO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:71 CALLE CARAZO
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-5700
Mailing Address - Country:US
Mailing Address - Phone:787-720-3643
Mailing Address - Fax:787-272-0833
Practice Address - Street 1:71 CALLE CARAZO
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-5700
Practice Address - Country:US
Practice Address - Phone:787-720-3643
Practice Address - Fax:787-272-0833
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR105291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0031068Medicare PIN