Provider Demographics
NPI:1790848554
Name:LAB. CLINICO CARRAIZO
Entity Type:Organization
Organization Name:LAB. CLINICO CARRAIZO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NEFTALI
Authorized Official - Middle Name:
Authorized Official - Last Name:TOLEDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-755-5060
Mailing Address - Street 1:URB RIACHUELO
Mailing Address - Street 2:RO 8 CALLE PLAZA ESTE
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976
Mailing Address - Country:US
Mailing Address - Phone:787-755-5060
Mailing Address - Fax:787-946-0363
Practice Address - Street 1:CARR 844 KM 5.6
Practice Address - Street 2:BO. CARRAIZO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-755-5060
Practice Address - Fax:787-755-5060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR918291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0031280Medicare PIN