Provider Demographics
NPI:1689472813
Name:ELITE CARE LABORATORY
Entity type:Organization
Organization Name:ELITE CARE LABORATORY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HIRAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:ORTEGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-431-6710
Mailing Address - Street 1:1250 AVE PONCE DE LEON STE 204
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907-3949
Mailing Address - Country:US
Mailing Address - Phone:787-641-0171
Mailing Address - Fax:
Practice Address - Street 1:BO. CAIMITAL
Practice Address - Street 2:CARR PR 2 KM 122.0
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00605
Practice Address - Country:US
Practice Address - Phone:787-641-0171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHP ELITE CARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-03-04
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory