MEDICARE: LABORATORIO CLINICO DEL PARQUE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	660491943	OTHER		AMERICAN HEALTH MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	20137	OTHER	AMERICAN HEALTH INC
3	9090086	OTHER	HUMANA HMO POS MEDICAL
4	660491943	OTHER	HUMANA GOLD CHOICE
5	660491943	OTHER	MEDICAL CARD SYSTEM REFOR
6	660491943	OTHER	OPTION HEALTH CARE NETWOR
7	9090086	OTHER	HUMANA HEALTH PLAN OF PR
8	051667	OTHER	LA CRUZ AZUL DE PUERTO RI
9	660491943	OTHER	COSVIMED
10	660491943	OTHER	CIGNA PROVIDER SERVICES
11	660491943	OTHER	MAPFRE EXCEL
12	LA037	OTHER	PAN AMERICAN LIFE INS CO
13	660491943	OTHER	MCS CLASSICARE
14	660491943	OTHER	MEDICAL CARD SYSTEM
15	800464	OTHER	MMM HEALTHCARE
16	400322	OTHER	PREFERRED
17	660491943	OTHER	INTERNATIONAL MEDICAL CAR
18	660491943	OTHER	MAPFRE LIFE
19	660491943	OTHER	PALIC PROVIDER NETWORK

General Provider Information

NPI Number	:	1588730923
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LABORATORIO CLINICO DEL PARQUE INC

Provider Business Mailing Address
First Line	:	PO BOX 41028
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00940-1028
Country	:	US
Telephone Number	:	787-724-4161
Fax Number	:	787-724-4161

Provider Business Practice Location Address
First Line	:	352 CALLE DEL PARQUE
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00912-3702
Country	:	US
Telephone Number	:	787-724-4161
Fax Number	:	787-724-4161

Authorized Official
Title or Position	:	DIRECTOR
Name	:	CARLOS M HIRALDO
Credential	:	TECNOLOGO MEDICO
Telephone Number	:	787-724-4161

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	07/31/2008

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