Provider Demographics
NPI:1699775379
Name:LABORATORIO CLINICO ORTEGA, INC.
Entity type:Organization
Organization Name:LABORATORIO CLINICO ORTEGA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:IDITH
Authorized Official - Middle Name:Y
Authorized Official - Last Name:CINTRON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-869-3265
Mailing Address - Street 1:PO BOX 725
Mailing Address - Street 2:
Mailing Address - City:NARANJITO
Mailing Address - State:PR
Mailing Address - Zip Code:00719-0725
Mailing Address - Country:US
Mailing Address - Phone:787-869-3265
Mailing Address - Fax:787-869-2562
Practice Address - Street 1:CALLE GEORGETTI #64
Practice Address - Street 2:
Practice Address - City:NARANJITO
Practice Address - State:PR
Practice Address - Zip Code:00719-3027
Practice Address - Country:US
Practice Address - Phone:787-869-3265
Practice Address - Fax:787-869-2562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-26
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR267291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR38266Medicare ID - Type Unspecified