Provider Demographics
NPI:1174924393
Name:LABORATORIO CLINICO CDT TOA ALTA
Entity type:Organization
Organization Name:LABORATORIO CLINICO CDT TOA ALTA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTORA
Authorized Official - Prefix:MISS
Authorized Official - First Name:ARACELIS
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA MERCADO
Authorized Official - Suffix:
Authorized Official - Credentials:TECNOLOGO MEDICO
Authorized Official - Phone:787-230-7190
Mailing Address - Street 1:PO BOX 1649
Mailing Address - Street 2:
Mailing Address - City:CANOVANAS
Mailing Address - State:PR
Mailing Address - Zip Code:00729
Mailing Address - Country:UM
Mailing Address - Phone:787-230-7190
Mailing Address - Fax:787-230-7190
Practice Address - Street 1:16 CALLE ANTONIO R BARCELO
Practice Address - Street 2:
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953
Practice Address - Country:UM
Practice Address - Phone:787-230-7190
Practice Address - Fax:787-230-7190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-08
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR706291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory