Provider Demographics
NPI:1457354011
Name:LABORATORIO CLINICO LEVITTOWN, INC.
Entity Type:Organization
Organization Name:LABORATORIO CLINICO LEVITTOWN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:LORENZANA
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-784-0813
Mailing Address - Street 1:PO BOX 51903
Mailing Address - Street 2:
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00950-1903
Mailing Address - Country:US
Mailing Address - Phone:787-784-0813
Mailing Address - Fax:787-795-5330
Practice Address - Street 1:S-15 CALLE LEALTAD LEVITTOWN
Practice Address - Street 2:
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949
Practice Address - Country:US
Practice Address - Phone:787-784-0813
Practice Address - Fax:787-795-5330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-27
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR310291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory