Provider Demographics
NPI:1831407048
Name:LABORATORIO CLINICO JEZER
Entity type:Organization
Organization Name:LABORATORIO CLINICO JEZER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-877-2010
Mailing Address - Street 1:HC 5 BOX 10433
Mailing Address - Street 2:
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676-9713
Mailing Address - Country:US
Mailing Address - Phone:787-877-2010
Mailing Address - Fax:787-877-2010
Practice Address - Street 1:CARR 110 KM 10.6
Practice Address - Street 2:
Practice Address - City:MOCA
Practice Address - State:PR
Practice Address - Zip Code:00676-9713
Practice Address - Country:US
Practice Address - Phone:787-877-2010
Practice Address - Fax:787-877-2010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-22
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory