Provider Demographics
NPI:1124095286
Name:LABORATORIO CLINICO PROFESIONAL EMANUEL INC
Entity type:Organization
Organization Name:LABORATORIO CLINICO PROFESIONAL EMANUEL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORIO
Authorized Official - Middle Name:
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:LCDO
Authorized Official - Phone:787-212-0119
Mailing Address - Street 1:MANSION DEL SUR
Mailing Address - Street 2:64 CEIBA STREET
Mailing Address - City:COTO LAUREL
Mailing Address - State:PR
Mailing Address - Zip Code:00780-2086
Mailing Address - Country:US
Mailing Address - Phone:787-260-5504
Mailing Address - Fax:787-837-8041
Practice Address - Street 1:CARR. 149 KM 63.9 BO. GUAYABAL MARGINAL #191
Practice Address - Street 2:
Practice Address - City:JUANA DIAZ
Practice Address - State:PR
Practice Address - Zip Code:00795
Practice Address - Country:US
Practice Address - Phone:787-260-5504
Practice Address - Fax:787-837-8041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-07
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR907291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR31154Medicare ID - Type Unspecified