Provider Demographics
NPI:1457609265
Name:EDGARDO GONZALEZ BIANCHI
Entity Type:Organization
Organization Name:EDGARDO GONZALEZ BIANCHI
Other - Org Name:LABORATORIO CLINICO TORRECILLAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDGARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ-BIANCHI
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-862-9900
Mailing Address - Street 1:20 VISTA DEL VALLE
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-4970
Mailing Address - Country:US
Mailing Address - Phone:787-862-9900
Mailing Address - Fax:
Practice Address - Street 1:CARR PR 155 KM 51.2
Practice Address - Street 2:BO TORRECILLAS
Practice Address - City:MOROVIS
Practice Address - State:PR
Practice Address - Zip Code:00687-2425
Practice Address - Country:US
Practice Address - Phone:787-862-9900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-28
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1262291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory