Provider Demographics
NPI:1205889615
Name:LABORATORIO CLINICO DCN CORP
Entity type:Organization
Organization Name:LABORATORIO CLINICO DCN CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:M
Authorized Official - Last Name:HORTA GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-782-3627
Mailing Address - Street 1:106 SUR MUNOZ RIVERA AVE.
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00986
Mailing Address - Country:US
Mailing Address - Phone:787-762-2280
Mailing Address - Fax:787-762-9420
Practice Address - Street 1:CANDOMINIO JESUS M SANROMA NUMBER 103
Practice Address - Street 2:CALLE MUNOZ RIVERA
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985
Practice Address - Country:US
Practice Address - Phone:787-762-2280
Practice Address - Fax:787-782-9420
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LABORATORIO CLINICO DCN CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-18
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR364291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0031511Medicare PIN