Provider Demographics
NPI:1871660043
Name:LABORATORIO CLINICO LOMAR INC.
Entity Type:Organization
Organization Name:LABORATORIO CLINICO LOMAR INC.
Other - Org Name:LABORATORIO CLINICO LOMAR INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:LARACUENTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-871-1205
Mailing Address - Street 1:16 CALLE PALMER STE A
Mailing Address - Street 2:
Mailing Address - City:CIALES
Mailing Address - State:PR
Mailing Address - Zip Code:00638-3251
Mailing Address - Country:US
Mailing Address - Phone:787-871-1205
Mailing Address - Fax:787-871-1205
Practice Address - Street 1:16 CALLE PALMER STE A
Practice Address - Street 2:
Practice Address - City:CIALES
Practice Address - State:PR
Practice Address - Zip Code:00638-3251
Practice Address - Country:US
Practice Address - Phone:787-871-1205
Practice Address - Fax:787-871-1205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR633291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
30465OtherSSS
20225OtherSSS
=========01OtherCOSBI
20225OtherSSS
20225OtherSSS
660494656LMedicare ID - Type Unspecified