Healthcare Provider Details

I. General information

NPI: 1083619019
Provider Name (Legal Business Name): LABORATORIO CLINICO LA 100 INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 10/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 CARR 100 SUITE 103
CABO ROJO PR
00623-4445
US

IV. Provider business mailing address

2301 CARR 100 SUITE 103
CABO ROJO PR
00623-4445
US

V. Phone/Fax

Practice location:
  • Phone: 787-255-0100
  • Fax: 787-851-0100
Mailing address:
  • Phone: 787-255-0100
  • Fax: 787-851-0100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number1044
License Number StatePR

VIII. Authorized Official

Name: MRS. ARACELYS MORALES
Title or Position: PRESIDENT
Credential: MT
Phone: 787-255-0100