Provider Demographics
NPI:1043103484
Name:TERESITA LAB LLC
Entity type:Organization
Organization Name:TERESITA LAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:ZAMARA
Authorized Official - Last Name:GONZALEZ QUIJANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-675-0112
Mailing Address - Street 1:MIRABELLA VILLAGE
Mailing Address - Street 2:23A CALLE CUARZO
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961
Mailing Address - Country:US
Mailing Address - Phone:787-675-0112
Mailing Address - Fax:
Practice Address - Street 1:LOCAL 3R SUITE 201 PLAZA RIO HONDO MALL
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961
Practice Address - Country:US
Practice Address - Phone:787-716-7050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-03
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory