Provider Demographics
NPI:1801364880
Name:PUERTO RICO CLINICAL REFERENCE LABORATORY
Entity Type:Organization
Organization Name:PUERTO RICO CLINICAL REFERENCE LABORATORY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:A
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:787-246-4698
Mailing Address - Street 1:APT 261 DR PEDRO BLANCO TORRE MEDICA II
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674
Mailing Address - Country:US
Mailing Address - Phone:787-395-7748
Mailing Address - Fax:787-680-0183
Practice Address - Street 1:CARR 2 KM 47 HM 5 EDIF DOCTORS CENTER HOSPITAL
Practice Address - Street 2:BO COTTO NORTE
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-395-7748
Practice Address - Fax:787-680-0183
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-11-07
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory