Provider Demographics
NPI:1104430883
Name:LABORATORIO CLINICO OTOAO LLC
Entity type:Organization
Organization Name:LABORATORIO CLINICO OTOAO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOHANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:NIEVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-310-3018
Mailing Address - Street 1:PO BOX 1464
Mailing Address - Street 2:
Mailing Address - City:UTUADO
Mailing Address - State:PR
Mailing Address - Zip Code:00641-1464
Mailing Address - Country:US
Mailing Address - Phone:787-310-3018
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA # 111, KM. 2.9, VIVI ABAJO,
Practice Address - Street 2:
Practice Address - City:UTUADO
Practice Address - State:PR
Practice Address - Zip Code:00641
Practice Address - Country:US
Practice Address - Phone:787-310-3018
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-01
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory