Provider Demographics
NPI:1760789556
Name:EASTERN VALLEY CLINICAL LABORATORIES, INC.
Entity Type:Organization
Organization Name:EASTERN VALLEY CLINICAL LABORATORIES, INC.
Other - Org Name:LABORATORIO CLINICO EASTERN VALLEY
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL TECHNOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ELISA
Authorized Official - Middle Name:B
Authorized Official - Last Name:PACHECO
Authorized Official - Suffix:
Authorized Official - Credentials:MS, MT (ASCP)
Authorized Official - Phone:787-655-7755
Mailing Address - Street 1:10 CALLE ICACOS
Mailing Address - Street 2:THE VILLAGE AT THE HILL
Mailing Address - City:CEIBA
Mailing Address - State:PR
Mailing Address - Zip Code:00735-3902
Mailing Address - Country:US
Mailing Address - Phone:787-398-4758
Mailing Address - Fax:787-655-7755
Practice Address - Street 1:CARR 976 KM 2.7
Practice Address - Street 2:BO FLORENCIO
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738
Practice Address - Country:US
Practice Address - Phone:787-655-7755
Practice Address - Fax:787-655-7755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-15
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1233291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory