Provider Demographics
NPI:1851469613
Name:ASHFORD ENDOCRINE & METABOLIC LABORATORY INC
Entity Type:Organization
Organization Name:ASHFORD ENDOCRINE & METABOLIC LABORATORY INC
Other - Org Name:ASHFORD MEDICAL LABORATORY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:COLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-452-9504
Mailing Address - Street 1:29 WASHINGTON STREET
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907
Mailing Address - Country:US
Mailing Address - Phone:787-724-6816
Mailing Address - Fax:787-724-7693
Practice Address - Street 1:29 WASHINGTON STREET
Practice Address - Street 2:SUITE 210
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907
Practice Address - Country:US
Practice Address - Phone:787-724-6816
Practice Address - Fax:787-724-7693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR130291U00000X
PR40D0658241291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
4000658241OtherCLIA
38116Medicare ID - Type Unspecified