Provider Demographics
NPI:1871646232
Name:LABORATORIO CLINICO CAGUAS CENTRO INC
Entity Type:Organization
Organization Name:LABORATORIO CLINICO CAGUAS CENTRO INC
Other - Org Name:PRISCILLA ROSA PANIAGUA
Other - Org Type:Other Name
Authorized Official - Title/Position:LABORATORY DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PRISCILLA
Authorized Official - Middle Name:ROSA
Authorized Official - Last Name:PANIAGUA
Authorized Official - Suffix:
Authorized Official - Credentials:BSMT
Authorized Official - Phone:787-745-5995
Mailing Address - Street 1:PO BOX 522
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-0522
Mailing Address - Country:US
Mailing Address - Phone:787-745-5995
Mailing Address - Fax:787-743-5893
Practice Address - Street 1:48 CALLE CELIS AGUILERA
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-2611
Practice Address - Country:US
Practice Address - Phone:787-745-5995
Practice Address - Fax:787-743-5893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR82291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0031163Medicare ID - Type UnspecifiedCLINICAL LABORATORY