Provider Demographics
NPI:1356417232
Name:BRAIN BIOLOGY LAB. P.S.C.
Entity type:Organization
Organization Name:BRAIN BIOLOGY LAB. P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MONGE CORTES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-791-9630
Mailing Address - Street 1:PO BOX 79875
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00984-9875
Mailing Address - Country:US
Mailing Address - Phone:787-791-9630
Mailing Address - Fax:787-791-8481
Practice Address - Street 1:187 CALLE DALIA
Practice Address - Street 2:SUITE 219 ISLA VERDE MALL
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00979
Practice Address - Country:US
Practice Address - Phone:787-791-9630
Practice Address - Fax:787-791-8481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-24
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1113291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory