Provider Demographics
NPI:1932220928
Name:FIRST CLINICAL LAB
Entity Type:Organization
Organization Name:FIRST CLINICAL LAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:MR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:MORALES
Authorized Official - Last Name:SEDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-764-5073
Mailing Address - Street 1:1007 AVE MUNOZ RIVERA
Mailing Address - Street 2:COND DARLINGTON L-13
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00925-2717
Mailing Address - Country:US
Mailing Address - Phone:787-764-5073
Mailing Address - Fax:787-753-0276
Practice Address - Street 1:1007 AVE MUNOZ RIVERA
Practice Address - Street 2:COND DARLINGTON L-13
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00925
Practice Address - Country:US
Practice Address - Phone:787-764-5073
Practice Address - Fax:787-753-0276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR38142Medicare PIN