Provider Demographics
NPI:1841287752
Name:LABORATORIO CLINICO BOQUERON INC
Entity type:Organization
Organization Name:LABORATORIO CLINICO BOQUERON INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:DE LOS ANGELES
Authorized Official - Last Name:OCASIO
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-254-2550
Mailing Address - Street 1:PO BOX 323
Mailing Address - Street 2:
Mailing Address - City:BOQUERON
Mailing Address - State:PR
Mailing Address - Zip Code:00622-0323
Mailing Address - Country:US
Mailing Address - Phone:787-254-2550
Mailing Address - Fax:787-254-2550
Practice Address - Street 1:CALLE LUIS MUNOZ RIVERA #63
Practice Address - Street 2:
Practice Address - City:BOQUERON
Practice Address - State:PR
Practice Address - Zip Code:00622
Practice Address - Country:US
Practice Address - Phone:787-254-2550
Practice Address - Fax:787-254-2550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-05
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR803291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR40D0658031OtherCLIA
PR40D0658031OtherCLIA