Provider Demographics
NPI:1174532568
Name:LABORATORIO CLINICO LA CUMBRE, INC
Entity type:Organization
Organization Name:LABORATORIO CLINICO LA CUMBRE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:O
Authorized Official - Last Name:ALSINA
Authorized Official - Suffix:
Authorized Official - Credentials:LIC
Authorized Official - Phone:787-720-7788
Mailing Address - Street 1:AVE PONCE DE LEON
Mailing Address - Street 2:#662
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-1000
Mailing Address - Country:US
Mailing Address - Phone:787-720-7788
Mailing Address - Fax:787-287-6495
Practice Address - Street 1:264 CALLE SIERRA MORENA
Practice Address - Street 2:URB. LA CUMBRE
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-5539
Practice Address - Country:US
Practice Address - Phone:787-720-7788
Practice Address - Fax:787-287-6495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR505291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR505OtherLICENSE PR
PR38148Medicare ID - Type Unspecified