Provider Demographics
NPI:1174756704
Name:CLINICAL & LABORATORY MANAGEMENT
Entity type:Organization
Organization Name:CLINICAL & LABORATORY MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EJECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:COLLAZO
Authorized Official - Middle Name:ORTIZ
Authorized Official - Last Name:MARISOL
Authorized Official - Suffix:
Authorized Official - Credentials:MT MS
Authorized Official - Phone:787-739-2054
Mailing Address - Street 1:CALLE BARCELO NUM 12 ESQ CARR 173 CIDRA, PR
Mailing Address - Street 2:PMB 1111 BOX 6400
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00737-6400
Mailing Address - Country:US
Mailing Address - Phone:787-739-2054
Mailing Address - Fax:787-739-5525
Practice Address - Street 1:STREET BARCELO NUM 12 CORNER 173 CIDRA PR 00739
Practice Address - Street 2:PMB 1111 BOX 6400
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00737-6400
Practice Address - Country:US
Practice Address - Phone:797-739-2054
Practice Address - Fax:787-739-5525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-31
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR122261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center