Provider Demographics
NPI:1063961621
Name:LABORATORIO CLINICO COSTA ISABELAII INC
Entity type:Organization
Organization Name:LABORATORIO CLINICO COSTA ISABELAII INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-900-4820
Mailing Address - Street 1:AVE JOBOS 8165 STE 1
Mailing Address - Street 2:
Mailing Address - City:ISABELA
Mailing Address - State:PUERTO RICO (PR)
Mailing Address - Zip Code:00662
Mailing Address - Country:UM
Mailing Address - Phone:787-900-4820
Mailing Address - Fax:787-872-4603
Practice Address - Street 1:BO PALMAR CARR 111 KM 1.8
Practice Address - Street 2:
Practice Address - City:AGUADILLA
Practice Address - State:PUERTO RICO (PR)
Practice Address - Zip Code:00603
Practice Address - Country:UM
Practice Address - Phone:787-900-4820
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-23
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory