Provider Demographics
NPI: | 1821582875 |
---|---|
Name: | LABORATORIO AVANZADO INC |
Entity Type: | Organization |
Organization Name: | LABORATORIO AVANZADO INC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | ADMINISTRATOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | ANA |
Authorized Official - Middle Name: | A |
Authorized Official - Last Name: | CESPEDES |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MT |
Authorized Official - Phone: | 787-614-3865 |
Mailing Address - Street 1: | 206 CALLE COQUI PITITO |
Mailing Address - Street 2: | URB BOSQUES DE LA SIERRA |
Mailing Address - City: | CAGUAS |
Mailing Address - State: | PR |
Mailing Address - Zip Code: | 00725 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 787-614-3865 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 100 GRAND PASEO BLVD STE 111 |
Practice Address - Street 2: | |
Practice Address - City: | SAN JUAN |
Practice Address - State: | PR |
Practice Address - Zip Code: | 00926 |
Practice Address - Country: | US |
Practice Address - Phone: | 787-614-3865 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2018-06-21 |
Last Update Date: | 2018-08-17 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 291U00000X | Laboratories | Clinical Medical Laboratory |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
PR | ========= | Other | LABORATORIO AVANZADO |