Provider Demographics
NPI:1932410545
Name:LABORATORIO CLINICO COAMO INCORPORATED
Entity Type:Organization
Organization Name:LABORATORIO CLINICO COAMO INCORPORATED
Other - Org Name:LABORATORIO CLINICO FLAMBOYAN
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVILA-MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-306-3985
Mailing Address - Street 1:1353 AVE LUIS VIGOREAUX
Mailing Address - Street 2:PMB 646
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966
Mailing Address - Country:US
Mailing Address - Phone:787-306-3985
Mailing Address - Fax:
Practice Address - Street 1:172 AVENUE KM 7.5
Practice Address - Street 2:BO. BAYAMON SECTOR CERTENEJAS
Practice Address - City:CIDRA
Practice Address - State:PR
Practice Address - Zip Code:00739
Practice Address - Country:US
Practice Address - Phone:787-306-3985
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-29
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory