Provider Demographics
NPI:1487051181
Name:LABORATORIO CLINICO PRINCIPAL SAN FERNANDO, INC
Entity type:Organization
Organization Name:LABORATORIO CLINICO PRINCIPAL SAN FERNANDO, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROSEANNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:AMADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-919-7060
Mailing Address - Street 1:PO BOX 1528
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-1528
Mailing Address - Country:US
Mailing Address - Phone:787-919-7060
Mailing Address - Fax:787-919-7061
Practice Address - Street 1:CARR. #2 KM 7.56 EDIF. 171
Practice Address - Street 2:SECTOR JUAN DOMINGO, BARRIO PUEBLO VIEJO
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00966
Practice Address - Country:US
Practice Address - Phone:787-919-7060
Practice Address - Fax:787-919-7061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-24
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory