Laboratorio Clinico Fair View CSP

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

1051 Issued in PR

Legal business name

LABORATORIO CLINICO FAIR VIEW CSP

Practice address

Carretera 845 KM 3.3
Centro Comercial Fairview Suite 7
Trujillo Alto, PR 00976

Phone

(787) 292-8789

Fax

(787) 292-8757

NPI assigned

Oct 24, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Luis Ortega Verge

Title

Owner and Administrator

Phone

(787) 292-8789

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in PR

Enrollment records 1

Locations

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

{
    "created_epoch": "1161648000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1467158400000",
    "number": "1316021504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "EL SENORIAL MAIL STATION",
            "address_2": "MSC 779",
            "city": "SAN JUAN",
            "state": "PR",
            "postal_code": "009266023",
            "telephone_number": "787-292-8789",
            "fax_number": "787-292-8757"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "CARRETERA 845 KM 3.3",
            "address_2": "CENTRO COMERCIAL FAIRVIEW SUITE 7",
            "city": "TRUJILLO ALTO",
            "state": "PR",
            "postal_code": "00976",
            "telephone_number": "787-292-8789",
            "fax_number": "787-292-8757"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LABORATORIO CLINICO FAIR VIEW CSP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-24",
        "last_updated": "2016-06-29",
        "status": "A",
        "authorized_official_last_name": "ORTEGA VERGE",
        "authorized_official_first_name": "LUIS",
        "authorized_official_title_or_position": "OWNER AND ADMINISTRATOR",
        "authorized_official_telephone_number": "787-292-8789",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "PR",
            "license": "1051",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Medical Laboratory in Trujillo Alto, PR
• Providers in Trujillo Alto, PR by specialty
• Clinical Medical Laboratory in Puerto Rico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2016; 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.