Provider Demographics
NPI:1336910827
Name:EXPRESS LAB LLC
Entity Type:Organization
Organization Name:EXPRESS LAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CLARISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-234-0770
Mailing Address - Street 1:PO BOX 1127
Mailing Address - Street 2:
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662-1127
Mailing Address - Country:US
Mailing Address - Phone:787-234-0770
Mailing Address - Fax:
Practice Address - Street 1:CARR. PR #113 KM 2.1 BO. GUAYABOS
Practice Address - Street 2:
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662-1127
Practice Address - Country:US
Practice Address - Phone:787-234-0770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-12
Last Update Date:2024-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory