Laboratorio Clinico Country Club

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

147 Issued in PR

Legal business name

LABORATORIO CLINICO COUNTRY CLUB

Practice address

758 Roberto Sanchez Vilella Street
Country Club
San Juan, PR 00926

Phone

(787) 748-2580

Fax

(787) 257-1110

NPI assigned

Feb 10, 2015

Organization subpart

No

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

Authorized official

Name

Eugenio Roman

Title

Administrator

Phone

(787) 748-4102

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in PR

Enrollment records 1

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.

• Laboratorio Clinico Country Club

  • Clinical Medical Laboratory
  • San Juan, PR
  • NPI 1154308674
  NPD tax ID

Locations

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

{
    "created_epoch": "1423526400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1423526400000",
    "number": "1437540671",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1353 AVE LUIS VIGOREAUX",
            "address_2": "PMB 364",
            "city": "GUAYNABO",
            "state": "PR",
            "postal_code": "009662715",
            "telephone_number": "787-748-2580",
            "fax_number": "787-257-1110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "758 ROBERTO SANCHEZ VILELLA STREET",
            "address_2": "COUNTRY CLUB",
            "city": "SAN JUAN",
            "state": "PR",
            "postal_code": "00926",
            "telephone_number": "787-748-2580",
            "fax_number": "787-257-1110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LABORATORIO CLINICO COUNTRY CLUB",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-10",
        "last_updated": "2015-02-10",
        "status": "A",
        "authorized_official_last_name": "ROMAN",
        "authorized_official_first_name": "EUGENIO",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "787-748-4102"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "PR",
            "license": "147",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Laboratorio Clinico CDT Dr. Javier J Anton
• Laboratorio Clinico CDT Dr. Jose Lopez Antongiorgi
• Laboratorio Clinico CDT Dr. Jose S Belaval
• Laboratorio Clinico Ciudadela Inc
• Laboratorio Clinico Country Club
• Laboratorio Clinico DCN Corp
• Laboratorio Clinico del Parque Inc
• Laboratorio Clinico Dr. Gualberto Rabell
• Laboratorio Clinico El Centro
• Laboratorio Clinico El Monte

• Clinical Medical Laboratory in San Juan, PR
• Providers in San Juan, 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 Feb 10, 2015; 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.