Ponce Clinical Laboratory, Inc.

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

273 Issued in PR

Legal business name

PONCE CLINICAL LABORATORY, INC.

Practice address

609 Tito Castro Ave
Suite 101
Ponce, PR 00716

Phone

(787) 841-4846

Fax

(787) 841-4846

NPI assigned

Feb 9, 2007

Organization subpart

No

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

Authorized official

Name

Mrs. Grycel Rosado Santiago, M.T.

Title

Owner

Phone

(787) 841-4846

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in PR

Enrollment records 1

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

{
    "created_epoch": "1170979200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1613088000000",
    "number": "1164563243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "609 TITO CASTRO AVE",
            "address_2": "SUITE 101",
            "city": "PONCE",
            "state": "PR",
            "postal_code": "00716",
            "telephone_number": "787-841-4846",
            "fax_number": "787-841-4846"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "609 TITO CASTRO AVE",
            "address_2": "SUITE 101",
            "city": "PONCE",
            "state": "PR",
            "postal_code": "00716",
            "telephone_number": "787-841-4846",
            "fax_number": "787-841-4846"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PONCE CLINICAL LABORATORY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-09",
        "last_updated": "2021-02-12",
        "certification_date": "2021-02-12",
        "status": "A",
        "authorized_official_last_name": "ROSADO SANTIAGO",
        "authorized_official_first_name": "GRYCEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "787-841-4846",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "M.T."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "PR",
            "license": "273",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ponce Advance Medical Group Network, Corp.
• Ponce Advance Medical Group, LLC
• Ponce Area Medical Equipment and Supply Corp
• Ponce Cardiology Group, P. S. C.
• Ponce Cardiovascular Services, PSC
• Ponce Clinical Laboratory, Inc.
• Ponce Clinical Laboratory, Inc.
• Ponce Conductual
• Ponce Dental Group
• Ponce Diagnostic Radiology Center CSP

• All providers in Ponce, PR
• Clinical Medical Laboratory in Puerto Rico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2021; 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.