Provider Demographics
NPI:1912952078
Name:LABORATORIO CLINICO DCN CORP
Entity Type:Organization
Organization Name:LABORATORIO CLINICO DCN CORP
Other - Org Name:LABORATORIO CLINICO DCN II
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:M
Authorized Official - Last Name:HORTA GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-782-3627
Mailing Address - Street 1:1432 AVE JESUS T PINERO
Mailing Address - Street 2:CAPARRA TERRACE
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00921-1517
Mailing Address - Country:US
Mailing Address - Phone:787-782-3627
Mailing Address - Fax:787-706-8603
Practice Address - Street 1:1432 AVE JESUS T PINERO
Practice Address - Street 2:CAPARRA TERRACE
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-1517
Practice Address - Country:US
Practice Address - Phone:787-782-3627
Practice Address - Fax:787-706-8603
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LABORATORIO CLINICO DCN CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-24
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR532291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0031512Medicare PIN