Provider Demographics
NPI:1790821809
Name:LABORATORIO CLINICO CORTES
Entity Type:Organization
Organization Name:LABORATORIO CLINICO CORTES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL TECHNOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:
Authorized Official - Last Name:JIMENEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-882-5050
Mailing Address - Street 1:534 AVE VICTORIA
Mailing Address - Street 2:URB GARCIA
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00603-4623
Mailing Address - Country:US
Mailing Address - Phone:787-882-5050
Mailing Address - Fax:787-882-5050
Practice Address - Street 1:534 AVE VICTORIA
Practice Address - Street 2:URB GARCIA
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603-4623
Practice Address - Country:US
Practice Address - Phone:787-882-5050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR989291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR=========OtherSS PATRONAL