Provider Demographics
NPI:1891228680
Name:CLINICAL LABORATORY SERVICES OF QUEBRADILLAS, INC.
Entity type:Organization
Organization Name:CLINICAL LABORATORY SERVICES OF QUEBRADILLAS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ELLIOT
Authorized Official - Middle Name:
Authorized Official - Last Name:MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:APA
Authorized Official - Phone:787-896-0503
Mailing Address - Street 1:PO BOX 2387
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-2387
Mailing Address - Country:US
Mailing Address - Phone:787-896-0503
Mailing Address - Fax:787-896-0503
Practice Address - Street 1:CARR 446 KM 3.5
Practice Address - Street 2:BO ROBLES
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685
Practice Address - Country:US
Practice Address - Phone:787-896-0503
Practice Address - Fax:787-896-0503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-07
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1242291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory