Provider Demographics
NPI:1194751081
Name:LABORATORIO CLINICO MAGDALENA INC.
Entity type:Organization
Organization Name:LABORATORIO CLINICO MAGDALENA INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/GENERAL SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LIZETTE
Authorized Official - Middle Name:J
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-725-5235
Mailing Address - Street 1:1452 ASHFORD AVE
Mailing Address - Street 2:SUITE 309
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907-1563
Mailing Address - Country:US
Mailing Address - Phone:787-725-5235
Mailing Address - Fax:787-725-5229
Practice Address - Street 1:1452 ASHFORD AVE
Practice Address - Street 2:SUITE 309
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-1563
Practice Address - Country:US
Practice Address - Phone:787-725-5235
Practice Address - Fax:787-725-5229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR579291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0031537Medicare PIN