Provider Demographics
NPI:1528678323
Name:LABORATORIO EBENEZER LLC
Entity type:Organization
Organization Name:LABORATORIO EBENEZER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAGMAR
Authorized Official - Middle Name:JOMARIE
Authorized Official - Last Name:CORREA
Authorized Official - Suffix:
Authorized Official - Credentials:MS,MT
Authorized Official - Phone:787-630-9149
Mailing Address - Street 1:HC 1 BOX 6131
Mailing Address - Street 2:
Mailing Address - City:GUAYANILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00656-9444
Mailing Address - Country:US
Mailing Address - Phone:787-630-9149
Mailing Address - Fax:
Practice Address - Street 1:BO MACANA CARR 132 KM 4.5
Practice Address - Street 2:
Practice Address - City:GUAYANILLA
Practice Address - State:PR
Practice Address - Zip Code:00656
Practice Address - Country:US
Practice Address - Phone:787-630-9149
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?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory