Provider Demographics
NPI:1144627241
Name:LABORATORIO CLINICO ANA CAMILA
Entity type:Organization
Organization Name:LABORATORIO CLINICO ANA CAMILA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL TECHNOLOGY
Authorized Official - Prefix:
Authorized Official - First Name:JOHANNY
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTIZ LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-421-6666
Mailing Address - Street 1:PR-3 KM 158-.5 SUITE B
Mailing Address - Street 2:URB. MINIMA LA CARMEN
Mailing Address - City:SALINAS
Mailing Address - State:PR
Mailing Address - Zip Code:00751-2319
Mailing Address - Country:US
Mailing Address - Phone:787-421-6666
Mailing Address - Fax:787-824-4333
Practice Address - Street 1:PR 3 KM 158.5
Practice Address - Street 2:URB. MINIMA LA CARMEN
Practice Address - City:SALINAS
Practice Address - State:PR
Practice Address - Zip Code:00751-2319
Practice Address - Country:US
Practice Address - Phone:787-421-6666
Practice Address - Fax:787-824-4333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-04
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1318291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory