Provider Demographics
NPI:1831851740
Name:LABORATORIO CLINICO ELENA LLC
Entity type:Organization
Organization Name:LABORATORIO CLINICO ELENA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:E
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MEDICAL TECHNOLOGY
Authorized Official - Phone:787-696-9146
Mailing Address - Street 1:TABAIBA TOWER APARTMENTS 259
Mailing Address - Street 2:CALLE CAGUANA APT. 104
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-1324
Mailing Address - Country:US
Mailing Address - Phone:787-651-6059
Mailing Address - Fax:
Practice Address - Street 1:AVE PADRE NOEL ESQ HOSTOS NUM 33
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-1324
Practice Address - Country:US
Practice Address - Phone:787-651-6058
Practice Address - Fax:787-651-6059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-07
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physicianGroup - Single Specialty