Provider Demographics
NPI:1437202975
Name:LABORATORIO CLINICO HENRIQUEZ
Entity type:Organization
Organization Name:LABORATORIO CLINICO HENRIQUEZ
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LABORATORY DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:HENRIQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:BMST
Authorized Official - Phone:787-743-0166
Mailing Address - Street 1:PO BOX 7528
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-7528
Mailing Address - Country:US
Mailing Address - Phone:787-743-0166
Mailing Address - Fax:787-744-4750
Practice Address - Street 1:F4 AVE DEGETAU
Practice Address - Street 2:BONNEVILLE TERRACE
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-5839
Practice Address - Country:US
Practice Address - Phone:787-743-0166
Practice Address - Fax:787-744-4750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR507291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0030316Medicare ID - Type UnspecifiedCLINICAL LABORATORY