Provider Demographics
NPI:1457337651
Name:ALCIDES OQUENDO SOLIS
Entity Type:Organization
Organization Name:ALCIDES OQUENDO SOLIS
Other - Org Name:LABORATORIO CLINICO CENTRAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:SEGARRA
Authorized Official - Last Name:DEL TORO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-852-3394
Mailing Address - Street 1:LABORATORIO CLINICO CENTRAL
Mailing Address - Street 2:AVENIDA FONT MARTELO 350
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00791
Mailing Address - Country:US
Mailing Address - Phone:787-852-3394
Mailing Address - Fax:787-852-3394
Practice Address - Street 1:AVENIDA MUNOZ MARIN #15
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791
Practice Address - Country:US
Practice Address - Phone:787-852-3394
Practice Address - Fax:787-852-3394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-20
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR791291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR38314Medicare PIN