Provider Demographics
NPI:1760448849
Name:LABORATORIO CLINICO BRUMBAUGH INC
Entity Type:Organization
Organization Name:LABORATORIO CLINICO BRUMBAUGH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:ISABEL
Authorized Official - Last Name:NIDO
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-763-5015
Mailing Address - Street 1:STREET # 1 C-1
Mailing Address - Street 2:SAN IGNACIO PARK
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00921
Mailing Address - Country:US
Mailing Address - Phone:787-763-5015
Mailing Address - Fax:787-766-3251
Practice Address - Street 1:STREET PINERO #80
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00925
Practice Address - Country:US
Practice Address - Phone:787-763-5015
Practice Address - Fax:787-766-3251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-26
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR367291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0030499OtherSSS
PR800014OtherMMM
PR0030499OtherSSS