Provider Demographics
NPI:1447411863
Name:GRUPO CLINICO DEL NORTE CSP
Entity type:Organization
Organization Name:GRUPO CLINICO DEL NORTE CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BSMT SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:MILAGROS
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-447-8484
Mailing Address - Street 1:BOX 3244
Mailing Address - Street 2:LABORATON CLINICO SAN VICENTE V
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674
Mailing Address - Country:US
Mailing Address - Phone:787-915-7700
Mailing Address - Fax:787-915-7700
Practice Address - Street 1:CARR 693 KM 14.7 SECTOR BRENAS
Practice Address - Street 2:LABORATON CLINIC SAN VICENTE V
Practice Address - City:VEGA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00692
Practice Address - Country:US
Practice Address - Phone:787-915-7700
Practice Address - Fax:787-915-7700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-18
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1124291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory