Provider Demographics
NPI:1336580638
Name:LAB CLINICO HERNANDEZ INC.
Entity Type:Organization
Organization Name:LAB CLINICO HERNANDEZ INC.
Other - Org Name:LABORATORIO CLINICO HERNANDEZ
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:LAB DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ILLIAD
Authorized Official - Middle Name:E
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-877-1895
Mailing Address - Street 1:PO BOX 357
Mailing Address - Street 2:
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676-0357
Mailing Address - Country:US
Mailing Address - Phone:787-877-1895
Mailing Address - Fax:787-551-7020
Practice Address - Street 1:85 CALLE DON CHEMARY
Practice Address - Street 2:
Practice Address - City:MOCA
Practice Address - State:PR
Practice Address - Zip Code:00676-4120
Practice Address - Country:US
Practice Address - Phone:787-877-1895
Practice Address - Fax:787-551-7020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-15
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR610291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
0030836Medicare PIN