Provider Demographics
NPI:1063769115
Name:LABORATORIO CONCORDIA LUGARO
Entity type:Organization
Organization Name:LABORATORIO CONCORDIA LUGARO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:DEL TORO
Authorized Official - Suffix:
Authorized Official - Credentials:BS MT ASCP
Authorized Official - Phone:787-612-0155
Mailing Address - Street 1:CALLE CONCORDIA 8151 EDIFICIO PROFESIONAL SUITE 2
Mailing Address - Street 2:SUITE2
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717
Mailing Address - Country:US
Mailing Address - Phone:787-840-0985
Mailing Address - Fax:
Practice Address - Street 1:8151 CALLE CONCORDIA
Practice Address - Street 2:SUITE 2
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1552
Practice Address - Country:US
Practice Address - Phone:787-840-0985
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-08
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR53291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0031145Medicare PIN