NPIMap

Organization Active NPI

Laboratorio Teresita

  • Clinical Medical Laboratory
  • Vega Alta, PR
National Provider Identifier
1275629388
Registry record updated May 30, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
License
720 Issued in PR
Legal business name
LABORATORIO TERESITA
Practice address
40 Calle Munoz Rivera
Vega Alta, PR 00692-6530
Phone
(787) 883-1009
Fax
(787) 883-1009
NPI assigned
Oct 5, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 30, 2019

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X 720 PR Primary

Addresses

Primary practice location

40 Calle Munoz Rivera
Vega Alta, PR 00692-6530

Mailing address

40 Calle Munoz Rivera
Vega Alta, PR 00692-6530
Phone (787) 883-1009

Other identifiers 6

IdentifierTypeStateIssuer
20225BOtherPMC
66049465902OtherHUMANA
660494659087OtherIMC
800232OtherSSS
31282OtherSSS
7620023AOtherHUMANA

Other names 1

  • Laboratorio Clinico Ebenezer Former legal business name

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
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

40 Calle Munoz Rivera
Vega Alta, PR 00692
Phone (787) 883-1009

NPI Registry JSON

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

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1559174400000",
    "number": "1275629388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40 CALLE MUNOZ RIVERA",
            "city": "VEGA ALTA",
            "state": "PR",
            "postal_code": "006926530",
            "telephone_number": "787-883-1009",
            "fax_number": "787-883-1009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40 CALLE MUNOZ RIVERA",
            "city": "VEGA ALTA",
            "state": "PR",
            "postal_code": "006926530",
            "telephone_number": "787-883-1009",
            "fax_number": "787-883-1009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LABORATORIO TERESITA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-05",
        "last_updated": "2019-05-30",
        "status": "A",
        "authorized_official_last_name": "GONZALEZ",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_middle_name": "ZAMARA",
        "authorized_official_title_or_position": "DUENA",
        "authorized_official_telephone_number": "787-675-0112"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "PR",
            "license": "720",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PMC",
            "identifier": "20225B",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HUMANA",
            "identifier": "66049465902",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IMC",
            "identifier": "660494659087",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SSS",
            "identifier": "800232",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SSS",
            "identifier": "31282",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HUMANA",
            "identifier": "7620023A",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Laboratorio Clinico Ebenezer",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Vega Alta, PR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2019; 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.