Provider Demographics
NPI:1871879197
Name:LABORATORIO CLINICON COLON #3
Entity type:Organization
Organization Name:LABORATORIO CLINICON COLON #3
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LABORATORY SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:YANIRE
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTRO
Authorized Official - Suffix:
Authorized Official - Credentials:MEDICAL TECNOLOGIST
Authorized Official - Phone:787-285-1680
Mailing Address - Street 1:PO BOX 85
Mailing Address - Street 2:
Mailing Address - City:YABUCOA
Mailing Address - State:PR
Mailing Address - Zip Code:00767-0085
Mailing Address - Country:US
Mailing Address - Phone:787-285-1680
Mailing Address - Fax:
Practice Address - Street 1:358 AVE FONT MARTELO
Practice Address - Street 2:ROSADO MEDICAL BUILDING
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791-3222
Practice Address - Country:US
Practice Address - Phone:787-285-1680
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LABORATORIO CLINICO DEL SURESTE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-11-01
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1032291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory