Provider Demographics
NPI:1023181732
Name:LABORATORIO CLINICO CHEGAR INC
Entity type:Organization
Organization Name:LABORATORIO CLINICO CHEGAR INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTORA
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:CEPEDA
Authorized Official - Suffix:
Authorized Official - Credentials:BS,MT,ASCP
Authorized Official - Phone:787-809-4697
Mailing Address - Street 1:PO BOX 497
Mailing Address - Street 2:
Mailing Address - City:RIO GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00745-0497
Mailing Address - Country:US
Mailing Address - Phone:787-887-6666
Mailing Address - Fax:787-887-6668
Practice Address - Street 1:CARR NUM 3 KM 26.2
Practice Address - Street 2:ENTRADA URB COCO BEACH
Practice Address - City:RIO GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00745
Practice Address - Country:US
Practice Address - Phone:787-887-6666
Practice Address - Fax:787-887-6668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR00902291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0031548Medicare PIN