Provider Demographics
NPI:1811035959
Name:JOEL ESTRADA MANGUAL
Entity Type:Organization
Organization Name:JOEL ESTRADA MANGUAL
Other - Org Name:LABORATORIO CLINICO CEDROS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ESTRADA
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-776-2492
Mailing Address - Street 1:SABANERA DEL RIO
Mailing Address - Street 2:CAMINO DE LOS LIRIOS 353
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778
Mailing Address - Country:US
Mailing Address - Phone:787-744-2016
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA 185 KM 12.6
Practice Address - Street 2:BARRIO CEDROS
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985
Practice Address - Country:US
Practice Address - Phone:787-776-2492
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0936291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory