Provider Demographics
NPI:1780956151
Name:LABORATORIO CLINICO JERICO, INC.
Entity type:Organization
Organization Name:LABORATORIO CLINICO JERICO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MERCADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-851-1007
Mailing Address - Street 1:30 CALLE SALVADOR BRAU
Mailing Address - Street 2:
Mailing Address - City:CABO ROJO
Mailing Address - State:PR
Mailing Address - Zip Code:00623-3417
Mailing Address - Country:US
Mailing Address - Phone:787-851-1007
Mailing Address - Fax:
Practice Address - Street 1:39 CALLE DR VEVE
Practice Address - Street 2:
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683-4191
Practice Address - Country:US
Practice Address - Phone:787-892-5565
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LABORATORIO CLINICO JERICO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-02-01
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0328291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory