Provider Demographics
NPI:1194714709
Name:LABORATORIO CLINICO PRINCIPAL INC
Entity type:Organization
Organization Name:LABORATORIO CLINICO PRINCIPAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSEANNE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:AMADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:783-960-0372
Mailing Address - Street 1:PO BOX 1528
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-1528
Mailing Address - Country:US
Mailing Address - Phone:787-780-5120
Mailing Address - Fax:787-780-8285
Practice Address - Street 1:BB26 AVE SANTA JUANITA
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956-4695
Practice Address - Country:US
Practice Address - Phone:787-780-5120
Practice Address - Fax:787-780-8285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR332291U00000X
PR291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR38357Medicare ID - Type Unspecified