NPIMap

Organization Active NPI

Laboratorio Teresita

  • Clinical Medical Laboratory
  • Bayamon, PR
National Provider Identifier
1124443213
Registry record updated Mar 25, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
Legal business name
LABORATORIO TERESITA
Practice address
J-1 Calle 3 Urb. Teresita
Bayamon, PR 00961
Phone
(787) 675-0112
NPI assigned
Feb 26, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2020

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

Authorized official

Name
Jessica Zamara Gonzalez
Title
President
Phone
(787) 675-0112

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X Primary

Addresses

Primary practice location

J-1 Calle 3 Urb. Teresita
Bayamon, PR 00961

Mailing address

Calle Cuarzo A23 Mirabella Village
Bayamon, PR 00956
Phone (787) 675-0112

Other identifiers 1

IdentifierTypeStateIssuer
IC614AMedicaidPR

Other names 1

  • LABORATORIO CLINICO TERESITA Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200828002763 PR Part B Supplier - Independent Clinical Laboratory 3577981364 4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Dorado, PR; Trujillo Alto, PR; Vega Alta, PR; Vega Baja, PR; Bayamon, PR

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Laboratorio Teresita5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1 Calle 3 W
Bayamon, PR 00961
Phone (787) 918-8887

NPI Registry JSON

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

{
    "created_epoch": "1393372800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1585094400000",
    "number": "1124443213",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "CALLE CUARZO A23 MIRABELLA VILLAGE",
            "city": "BAYAMON",
            "state": "PR",
            "postal_code": "00956",
            "telephone_number": "787-675-0112",
            "fax_number": "787-200-8762"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "J-1 CALLE 3 URB. TERESITA",
            "city": "BAYAMON",
            "state": "PR",
            "postal_code": "00961",
            "telephone_number": "787-675-0112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LABORATORIO TERESITA",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-02-26",
        "last_updated": "2020-03-25",
        "certification_date": "2020-03-25",
        "status": "A",
        "authorized_official_last_name": "GONZALEZ",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_middle_name": "ZAMARA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "787-675-0112"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "IC614A",
            "state": "PR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LABORATORIO CLINICO TERESITA",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "LABORATORIO CLINICO TERESITA",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bayamon, PR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 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.