Provider Demographics
NPI:1932280195
Name:CLENDO LAB INC.
Entity Type:Organization
Organization Name:CLENDO LAB INC.
Other - Org Name:CLENDO REFERENCE LAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:IDALIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BECERRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-620-9095
Mailing Address - Street 1:PO BOX 549
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-6049
Mailing Address - Country:US
Mailing Address - Phone:787-620-9095
Mailing Address - Fax:787-740-0902
Practice Address - Street 1:AVE. SANTA CRUZ #58 URB. STA. CRUZ
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-7020
Practice Address - Country:US
Practice Address - Phone:787-620-9095
Practice Address - Fax:787-740-0902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR526291U00000X
PRLIC.526291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR526OtherLICENCE
PR=========OtherTAX ID NUMBER
PR526OtherLICENCE