Provider Demographics
NPI:1679682397
Name:LABORATORIO CLINICO BORINQUEN-GURABO PLAZA
Entity type:Organization
Organization Name:LABORATORIO CLINICO BORINQUEN-GURABO PLAZA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:WHITLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-744-0330
Mailing Address - Street 1:2 CALLE BALDORIOTY
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-2606
Mailing Address - Country:US
Mailing Address - Phone:787-744-0330
Mailing Address - Fax:787-744-1717
Practice Address - Street 1:CARR. PR 189 KM. 7.8
Practice Address - Street 2:
Practice Address - City:GURABO
Practice Address - State:PR
Practice Address - Zip Code:00778
Practice Address - Country:US
Practice Address - Phone:787-737-2600
Practice Address - Fax:787-737-2606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1078291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory