Provider Demographics
NPI:1396813168
Name:LAB CLINICO CAGUAS NORTE
Entity type:Organization
Organization Name:LAB CLINICO CAGUAS NORTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DUENA
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIBEL
Authorized Official - Middle Name:RODRIGUEZ
Authorized Official - Last Name:CORUJO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-746-1665
Mailing Address - Street 1:PO BOX 1380
Mailing Address - Street 2:STREET LOPEZ FLORES
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778
Mailing Address - Country:US
Mailing Address - Phone:787-746-1665
Mailing Address - Fax:
Practice Address - Street 1:CALLE LOPEZ FLOREZ
Practice Address - Street 2:URB PARADIS B OFIC # 3
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-746-1665
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
100634OtherLA CRUZ DE PR
400589OtherUTI PREFERRED
A154OtherINTERNACIONAL
=========OtherHUMANA REFORMA
=========OtherHUMANA COMERCIAL
A154OtherINTERNACIONAL
=========OtherMCS CLASSICARE
=========OtherPALIC
400589OtherUTI PREFERRED
=========OtherHUMANA GOLD PLUS
=========OtherCOSVI