NPIMap

Organization Active NPI

Laboratorio Clinico Otoao LLC

  • Clinical Medical Laboratory
  • Utuado, PR
National Provider Identifier
1104430883
Registry record updated Sep 1, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
Legal business name
LABORATORIO CLINICO OTOAO LLC
Practice address
Carretera # 111, KM. 2.9, Vivi Abajo,
Utuado, PR 00641
Phone
(787) 310-3018
NPI assigned
Sep 1, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 1, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Johanna Nieves
Title
Owner
Phone
(787) 310-3018

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X Primary

Addresses

Primary practice location

Carretera # 111, KM. 2.9, Vivi Abajo,
Utuado, PR 00641

Mailing address

PO Box 1464
Utuado, PR 00641-1464
Phone (787) 310-3018

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210226000520 PR Part B Supplier - Independent Clinical Laboratory 0446665376 Practice locations: Utuado, PR

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1598918400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598918400000",
    "number": "1104430883",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1464",
            "city": "UTUADO",
            "state": "PR",
            "postal_code": "006411464",
            "telephone_number": "787-310-3018"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "CARRETERA # 111, KM. 2.9, VIVI ABAJO,",
            "city": "UTUADO",
            "state": "PR",
            "postal_code": "00641",
            "telephone_number": "787-310-3018"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LABORATORIO CLINICO OTOAO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-01",
        "last_updated": "2020-09-01",
        "certification_date": "2020-08-27",
        "status": "A",
        "authorized_official_last_name": "NIEVES",
        "authorized_official_first_name": "JOHANNA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "787-310-3018",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Utuado, PR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.