Provider Demographics
NPI:1821197393
Name:LABORATORIO CLINICO POMALES
Entity type:Organization
Organization Name:LABORATORIO CLINICO POMALES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LAB OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDRICK
Authorized Official - Middle Name:EDUARDO
Authorized Official - Last Name:POMALES
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-853-0382
Mailing Address - Street 1:PO BOX 1078
Mailing Address - Street 2:
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00785-1078
Mailing Address - Country:US
Mailing Address - Phone:787-853-0382
Mailing Address - Fax:787-853-0482
Practice Address - Street 1:STREET #3 KM 151.5
Practice Address - Street 2:
Practice Address - City:AGUIRRE
Practice Address - State:PR
Practice Address - Zip Code:00704
Practice Address - Country:US
Practice Address - Phone:787-853-0382
Practice Address - Fax:787-853-0482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1023291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory