Provider Demographics
NPI:1811999089
Name:LABORATORIO CLINICO GUAYNABO
Entity type:Organization
Organization Name:LABORATORIO CLINICO GUAYNABO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LABORATORY DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:D
Authorized Official - Last Name:GARCIA-DUCOS
Authorized Official - Suffix:
Authorized Official - Credentials:MS,MT, ASCP
Authorized Official - Phone:787-720-5556
Mailing Address - Street 1:26 CALLE HERMINIO DIAZ NAVARRO
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-5616
Mailing Address - Country:US
Mailing Address - Phone:787-720-5556
Mailing Address - Fax:787-789-6816
Practice Address - Street 1:26 CALLE HERMINIO DIAZ NAVARRO
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-5616
Practice Address - Country:US
Practice Address - Phone:787-720-5556
Practice Address - Fax:787-789-6816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-01
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR713291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR38254Medicare ID - Type Unspecified