Provider Demographics
NPI:1245821354
Name:LABORATORIO CLINICO PADUA LLC
Entity type:Organization
Organization Name:LABORATORIO CLINICO PADUA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TATIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MLS
Authorized Official - Phone:939-274-7854
Mailing Address - Street 1:HC 7 BOX 76533
Mailing Address - Street 2:
Mailing Address - City:SAN SEBASTIAN
Mailing Address - State:PR
Mailing Address - Zip Code:00685-7343
Mailing Address - Country:US
Mailing Address - Phone:939-274-7854
Mailing Address - Fax:
Practice Address - Street 1:CARR 125 KM 16.2 BO. GUATEMALA
Practice Address - Street 2:
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685-0068
Practice Address - Country:US
Practice Address - Phone:787-280-7854
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-01
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory