Provider Demographics
NPI:1043329873
Name:LABORATORIO CLINICO PUJOLS, INC.
Entity type:Organization
Organization Name:LABORATORIO CLINICO PUJOLS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRADORA
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAISY
Authorized Official - Middle Name:IVETTE
Authorized Official - Last Name:SOTO
Authorized Official - Suffix:
Authorized Official - Credentials:BBA
Authorized Official - Phone:787-896-7381
Mailing Address - Street 1:P.O. BOX 3692
Mailing Address - Street 2:HATO ARRIBA STATION
Mailing Address - City:SAN SEBASTIAN
Mailing Address - State:PR
Mailing Address - Zip Code:00685-7012
Mailing Address - Country:US
Mailing Address - Phone:787-896-7381
Mailing Address - Fax:787-896-7381
Practice Address - Street 1:CARR. 111 KM. 17.0
Practice Address - Street 2:
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685-7012
Practice Address - Country:US
Practice Address - Phone:787-896-7381
Practice Address - Fax:787-896-7381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1022291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR40D0982044OtherCLIA NUMBER