Provider Demographics
NPI:1942270343
Name:LABORATORIO CLINICO DOCTOR CENTER, INC.
Entity Type:Organization
Organization Name:LABORATORIO CLINICO DOCTOR CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILFREDO
Authorized Official - Middle Name:
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-762-4200
Mailing Address - Street 1:PO BOX 29491
Mailing Address - Street 2:65TH INFANTERY STATION
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00929-0491
Mailing Address - Country:US
Mailing Address - Phone:787-762-4200
Mailing Address - Fax:787-762-4200
Practice Address - Street 1:PC1 CALLE 274
Practice Address - Street 2:AVE. COMANDANTE, COUNTRY CLUB
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00982-2769
Practice Address - Country:US
Practice Address - Phone:787-762-4200
Practice Address - Fax:787-762-4200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-26
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR483291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0038132Medicare UPIN