Provider Demographics
NPI:1053383216
Name:LABORATORIO CLINICO ADAMS
Entity type:Organization
Organization Name:LABORATORIO CLINICO ADAMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPIETARIO
Authorized Official - Prefix:MR
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:LOPENENA BAIRETO
Authorized Official - Suffix:
Authorized Official - Credentials:PROPIETARIO
Authorized Official - Phone:787-882-5915
Mailing Address - Street 1:PO BOX 3088
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00605
Mailing Address - Country:US
Mailing Address - Phone:787-882-5975
Mailing Address - Fax:
Practice Address - Street 1:CARRATERA #2 KM 122.0
Practice Address - Street 2:BARRIO CORRALES FRENTE ESCUELA ADAMS
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00605
Practice Address - Country:US
Practice Address - Phone:787-882-5975
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-02
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
1010207OtherBLUE CROSS
400689OtherPRESERV HIATH
6030092OtherHUMANA
31489OtherTRIPLE S
1010207OtherBLUE CROSS
=========OtherAMERICAN LIFE
=========OtherTRI CARE
=========OtherCIGNA
400689OtherPRESERV HIATH
=========OtherCIGNA INTERNATIONAL