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General NPI Number Information
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NPI Number | 1639135502
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Entity Type | Organization
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Legal Business Name | LABORATORIO CLINICO PLAZA CAROLINA INC
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Dates
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Enumeration Date | 04/21/2006
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Last Update Date | 02/09/2024
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Provider Practice Location Address
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Address Line | AVE. FRAGOSO & EXPRESO LOIZA OFFICE #12 3ER NIVEL PLAZA CAROLINA MALL
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City | CAROLINA
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State | PR
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Zip | 00988
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Country | US
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Telephone | 787-768-0070
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Fax | 787-768-0070
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Provider Business Mailing Address
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Address Line | PO BOX 9741
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City | CAROLINA
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State | PR
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Zip | 00988-9741
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Country | US
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Telephone | 787-768-0070
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Fax | 787-768-0070
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Authorized Official
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Title or Position | SECRETARY (OWNER)
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Name | MR. EDGARDO GENARO PINEIRO SR.
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Credential | MD
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Telephone | 787-616-7253
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 871
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License Number State | PR
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