Provider Demographics
NPI:1386785533
Name:GILDA WILSON CLINICAL LABORATORY
Entity type:Organization
Organization Name:GILDA WILSON CLINICAL LABORATORY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL TECHNOLOGIST OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GILDA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-842-0112
Mailing Address - Street 1:31 MAYOR ST
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00730-3726
Mailing Address - Country:US
Mailing Address - Phone:787-842-0112
Mailing Address - Fax:787-842-0112
Practice Address - Street 1:31 MAYOR ST
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00730-3726
Practice Address - Country:US
Practice Address - Phone:787-842-0112
Practice Address - Fax:787-842-0112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0012291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory