Provider Demographics
NPI:1821136359
Name:LABORATORIO CLINICO MONTELLANO INC
Entity Type:Organization
Organization Name:LABORATORIO CLINICO MONTELLANO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:JANETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:FIGUEROA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-738-1920
Mailing Address - Street 1:PO BOX 6400
Mailing Address - Street 2:PMB 379
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00737-6400
Mailing Address - Country:US
Mailing Address - Phone:787-738-1920
Mailing Address - Fax:
Practice Address - Street 1:AVE ANTONIO R BARCELO
Practice Address - Street 2:CARR. #14 KM.72.3
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736-3717
Practice Address - Country:US
Practice Address - Phone:787-738-1920
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR958291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0031181Medicare PIN