Provider Demographics
NPI:1962858696
Name:GO GOGO FUNDACION CORP.
Entity Type:Organization
Organization Name:GO GOGO FUNDACION CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ULISES
Authorized Official - Middle Name:A
Authorized Official - Last Name:CLAVELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-974-2679
Mailing Address - Street 1:291 CALLE MONTERREY
Mailing Address - Street 2:URB. REPARADA INDUSTRIAL
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-0376
Mailing Address - Country:US
Mailing Address - Phone:787-974-2679
Mailing Address - Fax:
Practice Address - Street 1:291 CALLE MONTERREY
Practice Address - Street 2:URB. REPARADA INDUSTRIAL
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-0376
Practice Address - Country:US
Practice Address - Phone:787-974-2679
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-12
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14-100291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory