Provider Demographics
NPI:1356351621
Name:LABORATORIO CLINICO COLON, INC
Entity type:Organization
Organization Name:LABORATORIO CLINICO COLON, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL TECHNOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEIXTER
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:COLON
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-868-5620
Mailing Address - Street 1:272 CALLE MARINA
Mailing Address - Street 2:PO BOX 254
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602-2956
Mailing Address - Country:US
Mailing Address - Phone:787-868-5620
Mailing Address - Fax:
Practice Address - Street 1:272 CALLE MARINA
Practice Address - Street 2:
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602-2956
Practice Address - Country:US
Practice Address - Phone:787-868-5620
Practice Address - Fax:787-868-5620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR490291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR30868Medicare PIN