NPIMap

Organization Active NPI

Laboratorio Clinico Country Club

  • Clinical Medical Laboratory
  • San Juan, PR
National Provider Identifier
1154308674
Registry record updated Oct 21, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
License
147 Issued in PR
Legal business name
LABORATORIO CLINICO COUNTRY CLUB
Practice address
#758 Ave Campo Rico
Country Club
San Juan, PR 00924
Phone
(787) 750-0510
Fax
(787) 257-1110
NPI assigned
Dec 27, 2005
Last updated
Oct 21, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2008

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

Authorized official

Name
Edwin Cardona, MTNPI 1821243429
Title
Owner
Phone
(787) 748-4102

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X 147 PR Primary

Addresses

Primary practice location

#758 Ave Campo Rico
Country Club
San Juan, PR 00924

Mailing address

1353 Carr. #19
PMB #364
Guaynabo, PR 00966-2701
Phone (787) 750-0510

National Provider Directory

National Provider Directory
Tax ID family
Lab Clinico Country Club2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1135641600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1224547200000",
    "number": "1154308674",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1353 CARR. #19",
            "address_2": "PMB #364",
            "city": "GUAYNABO",
            "state": "PR",
            "postal_code": "009662701",
            "telephone_number": "787-750-0510",
            "fax_number": "787-257-1110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "#758 AVE CAMPO RICO",
            "address_2": "COUNTRY CLUB",
            "city": "SAN JUAN",
            "state": "PR",
            "postal_code": "00924",
            "telephone_number": "787-750-0510",
            "fax_number": "787-257-1110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LABORATORIO CLINICO COUNTRY CLUB",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-27",
        "last_updated": "2008-10-21",
        "status": "A",
        "authorized_official_last_name": "CARDONA",
        "authorized_official_first_name": "EDWIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "787-748-4102",
        "authorized_official_credential": "MT"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "PR",
            "license": "147",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Juan, PR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.