Provider Demographics
NPI:1184632721
Name:LABORATORIO CLINICO C & C , CSP
Entity type:Organization
Organization Name:LABORATORIO CLINICO C & C , CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENCIADO TECNOLOGO MEDICO
Authorized Official - Prefix:MR
Authorized Official - First Name:RUDERCINDO
Authorized Official - Middle Name:
Authorized Official - Last Name:CARABALLO
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-267-3869
Mailing Address - Street 1:PO BOX 5161
Mailing Address - Street 2:
Mailing Address - City:YAUCO
Mailing Address - State:PR
Mailing Address - Zip Code:00698-5161
Mailing Address - Country:US
Mailing Address - Phone:787-267-3869
Mailing Address - Fax:787-856-8061
Practice Address - Street 1:CARR 335 CENTRO COMERCIAL BARINAS SUITE 201
Practice Address - Street 2:BARRIO BARINAS
Practice Address - City:YAUCO
Practice Address - State:PR
Practice Address - Zip Code:00698
Practice Address - Country:US
Practice Address - Phone:787-267-3869
Practice Address - Fax:787-856-8061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR978291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR30018Medicare ID - Type Unspecified