Provider Demographics
NPI:1750991550
Name:DIRECTLAB LLC
Entity type:Organization
Organization Name:DIRECTLAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JACOBO
Authorized Official - Middle Name:
Authorized Official - Last Name:CONCEPCION
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-549-1085
Mailing Address - Street 1:PO BOX 2221
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-2221
Mailing Address - Country:US
Mailing Address - Phone:787-549-1085
Mailing Address - Fax:
Practice Address - Street 1:CALLE PARKSIDE CONDOMINO SAN PATRICIO 2
Practice Address - Street 2:APT 1228
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00968-0096
Practice Address - Country:US
Practice Address - Phone:787-549-1085
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-06
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Single Specialty