Provider Demographics
NPI:1750484135
Name:LABORATORIO CLINICO BEAUCHAMP
Entity Type:Organization
Organization Name:LABORATORIO CLINICO BEAUCHAMP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:BEAUCHAMP
Authorized Official - Suffix:
Authorized Official - Credentials:BSMT
Authorized Official - Phone:787-822-0081
Mailing Address - Street 1:10 DR VAZQUEZ COLON
Mailing Address - Street 2:
Mailing Address - City:FLORIDA
Mailing Address - State:PR
Mailing Address - Zip Code:00650
Mailing Address - Country:US
Mailing Address - Phone:787-822-3364
Mailing Address - Fax:787-822-3364
Practice Address - Street 1:10 DR VAZQUEZ COLON
Practice Address - Street 2:
Practice Address - City:FLORIDA
Practice Address - State:PR
Practice Address - Zip Code:00650
Practice Address - Country:US
Practice Address - Phone:787-822-3364
Practice Address - Fax:787-822-3364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR831291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
011831OtherGLOBAL HEALTH
051580OtherCRUZ AZUL
584683972OtherHAPFRE
584683972OtherMMM MCS
950OtherAPS
20042OtherAMERICAN HEALTH
21723OtherAHPR
584683972OtherMMM COSVI
20012OtherMMMPMC
584683972OtherCORVI
6500008OtherHUMANA
800084OtherMMM
1126OtherIMC
400367OtherUTI
PR584683972OtherMCS
6006523OtherACAA
PR30827OtherSSS
584683972OtherMMM COSVI
PR=========OtherCIGNA
6006523OtherACAA