Provider Demographics
NPI:1851370803
Name:NILLIAN L GUZMAN LABORATORIO CLINICO FAMILIAR
Entity Type:Organization
Organization Name:NILLIAN L GUZMAN LABORATORIO CLINICO FAMILIAR
Other - Org Name:LABORATORIO CLINICO FAMILIAR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LAB OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NILLIAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:GUZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-818-9028
Mailing Address - Street 1:PO BOX 358
Mailing Address - Street 2:
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676-0358
Mailing Address - Country:US
Mailing Address - Phone:787-818-9028
Mailing Address - Fax:787-818-9028
Practice Address - Street 1:AVE LA MOCA 202 CARR 111 KM 4.6
Practice Address - Street 2:SUITE 1 MOCA PROFESSIONAL CENTER
Practice Address - City:MOCA
Practice Address - State:PR
Practice Address - Zip Code:00676-0358
Practice Address - Country:US
Practice Address - Phone:787-818-9028
Practice Address - Fax:787-818-9028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-10
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
30064OtherMEDICARE PART B
584212329OtherCIGNA
584212329OtherMCS
30064OtherMEDICARE PART B