Provider Demographics
NPI:1356405641
Name:LABORATORIO CLINICO ALMACIGO
Entity type:Organization
Organization Name:LABORATORIO CLINICO ALMACIGO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECT OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:ISABEL
Authorized Official - Last Name:ASCANIO
Authorized Official - Suffix:
Authorized Official - Credentials:MSMTASCP
Authorized Official - Phone:1787-856-4463
Mailing Address - Street 1:PO BOX 801224
Mailing Address - Street 2:
Mailing Address - City:COTO LAUREL
Mailing Address - State:PR
Mailing Address - Zip Code:00780-1224
Mailing Address - Country:US
Mailing Address - Phone:787-856-4463
Mailing Address - Fax:787-856-4081
Practice Address - Street 1:ROAD 371 KM 1.7
Practice Address - Street 2:BO ALMACIGO BAJO
Practice Address - City:YAUCO
Practice Address - State:PR
Practice Address - Zip Code:00698
Practice Address - Country:US
Practice Address - Phone:787-856-4463
Practice Address - Fax:787-856-4081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1031291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR30950Medicare ID - Type Unspecified