Provider Demographics
NPI:1548486939
Name:GRISELLE E CARLO HIDALGO
Entity type:Organization
Organization Name:GRISELLE E CARLO HIDALGO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GRISELLE
Authorized Official - Middle Name:E
Authorized Official - Last Name:CARLO
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-833-4065
Mailing Address - Street 1:24 CALLE DR BASORA N
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680-4831
Mailing Address - Country:US
Mailing Address - Phone:787-833-4065
Mailing Address - Fax:787-805-6605
Practice Address - Street 1:24 CALLE DR BASORA N
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-4831
Practice Address - Country:US
Practice Address - Phone:787-833-4065
Practice Address - Fax:787-805-6605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR432291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR30258Medicare ID - Type Unspecified