Provider Demographics
NPI:1265546790
Name:LABORATORIO CLINICO BORGES
Entity type:Organization
Organization Name:LABORATORIO CLINICO BORGES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR & OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:IRIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:GONZALEZ DE BORGES
Authorized Official - Suffix:
Authorized Official - Credentials:MT(ASCP)
Authorized Official - Phone:787-751-6373
Mailing Address - Street 1:168 CALLE ARZUAGA
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00925-3424
Mailing Address - Country:US
Mailing Address - Phone:787-751-6373
Mailing Address - Fax:787-751-6375
Practice Address - Street 1:168 CALLE ARZUAGA
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00925-3424
Practice Address - Country:US
Practice Address - Phone:787-751-6373
Practice Address - Fax:787-751-6375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0080291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0038376Medicare PIN