Provider Demographics
NPI:1891882791
Name:LABORATORIO CLINICO PLAZA DEL MAR INC
Entity Type:Organization
Organization Name:LABORATORIO CLINICO PLAZA DEL MAR INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NILSA
Authorized Official - Middle Name:I
Authorized Official - Last Name:NUNEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-883-8150
Mailing Address - Street 1:PO BOX 3432
Mailing Address - Street 2:
Mailing Address - City:VEGA ALTA,
Mailing Address - State:PR
Mailing Address - Zip Code:00692-3432
Mailing Address - Country:US
Mailing Address - Phone:787-883-8150
Mailing Address - Fax:787-883-8117
Practice Address - Street 1:CARR. 693, KM 13.8
Practice Address - Street 2:PLAZA DEL MAR SHOPING CENTER, SUITE B-2
Practice Address - City:VEGA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00692-3432
Practice Address - Country:US
Practice Address - Phone:787-883-8150
Practice Address - Fax:787-883-8117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1110291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0031541Medicare PIN