Provider Demographics
NPI:1962470047
Name:LABORATORIO CLINICO MARGARITA
Entity Type:Organization
Organization Name:LABORATORIO CLINICO MARGARITA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LUISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-751-6887
Mailing Address - Street 1:1017 AVE GENERAL DEL VALLE
Mailing Address - Street 2:URB DELICIAS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00924
Mailing Address - Country:US
Mailing Address - Phone:787-764-7153
Mailing Address - Fax:787-751-6887
Practice Address - Street 1:1017 AVE GENERAL DEL VALLE
Practice Address - Street 2:URB DELICIAS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924
Practice Address - Country:US
Practice Address - Phone:787-764-7153
Practice Address - Fax:787-751-6887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR278291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR31016Medicare PIN