Provider Demographics
NPI:1952055055
Name:PUERTO RICO PRIMARY CARE, MSO, INC. - LABORATORIO
Entity Type:Organization
Organization Name:PUERTO RICO PRIMARY CARE, MSO, INC. - LABORATORIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KEILA
Authorized Official - Middle Name:
Authorized Official - Last Name:CENTENO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-534-3789
Mailing Address - Street 1:PO BOX 818
Mailing Address - Street 2:
Mailing Address - City:CEIBA
Mailing Address - State:PR
Mailing Address - Zip Code:00735-0818
Mailing Address - Country:US
Mailing Address - Phone:787-534-3789
Mailing Address - Fax:787-885-2525
Practice Address - Street 1:CALLE 14 DE JULIO NO 159
Practice Address - Street 2:BO MATA DE PLATANO
Practice Address - City:LUQUILLO
Practice Address - State:PR
Practice Address - Zip Code:00773
Practice Address - Country:US
Practice Address - Phone:787-885-4446
Practice Address - Fax:787-885-6129
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PUERTO RICO PRIMARY CARE MSO, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-02-08
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory