Provider Demographics
NPI:1154595965
Name:LABORATORIO CLINICO COSTA ISABELA INC.
Entity type:Organization
Organization Name:LABORATORIO CLINICO COSTA ISABELA 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:L
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCDA
Authorized Official - Phone:787-872-4603
Mailing Address - Street 1:8494 AVE JOBOS # PMB120
Mailing Address - Street 2:
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662-2143
Mailing Address - Country:US
Mailing Address - Phone:787-872-4603
Mailing Address - Fax:787-872-4603
Practice Address - Street 1:8494 AVE JOBOS # PMB120
Practice Address - Street 2:
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662-2143
Practice Address - Country:US
Practice Address - Phone:787-872-4603
Practice Address - Fax:787-872-4603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-14
Last Update Date:2008-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory