Provider Demographics
NPI:1982656294
Name:LABORATORIO CLINICO BORINQUEN
Entity Type:Organization
Organization Name:LABORATORIO CLINICO BORINQUEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPIETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:J
Authorized Official - Last Name:FEBLES
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:787-867-3007
Mailing Address - Street 1:M10 CALLE ESTRELLA DEL MAR
Mailing Address - Street 2:DORADO DEL MAR
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-2147
Mailing Address - Country:US
Mailing Address - Phone:787-867-3007
Mailing Address - Fax:787-867-3007
Practice Address - Street 1:CARRETERA #155 K M 31.5
Practice Address - Street 2:BO. GATO
Practice Address - City:OROCOVIS
Practice Address - State:PR
Practice Address - Zip Code:00720
Practice Address - Country:US
Practice Address - Phone:787-867-3007
Practice Address - Fax:787-867-3007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1048291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0031521Medicare PIN