Provider Demographics
NPI:1194950519
Name:LABORATORIO CLINICO PLAZA CAYEY, INC.
Entity type:Organization
Organization Name:LABORATORIO CLINICO PLAZA CAYEY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:BRENDALEE
Authorized Official - Middle Name:
Authorized Official - Last Name:MELENDEZ TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-672-0339
Mailing Address - Street 1:Z5-4 15 ST.
Mailing Address - Street 2:URB. TURABO GARDENS
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727
Mailing Address - Country:US
Mailing Address - Phone:787-738-3838
Mailing Address - Fax:787-738-3902
Practice Address - Street 1:CARR #1 KM. 55.2 SUITE 207
Practice Address - Street 2:CARIBBEAN CINEMAS BUILDING PLAZA CAYEY
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00737
Practice Address - Country:US
Practice Address - Phone:787-738-3838
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-29
Last Update Date:2009-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1188291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR40D1079185OtherCLIA