Laboratorio Clinico Divino Nino, Inc.

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

1312 Issued in PR

Legal business name

LABORATORIO CLINICO DIVINO NINO, INC.

Practice address

Bo. Plata Carr. 420 KM 4.4
Moca, PR 00676

Phone

(787) 551-7175

NPI assigned

Jun 2, 2014

Organization subpart

No

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

Authorized official

Name

Brendaliz Aviles, M.T.

Title

Supervisor

Phone

(787) 635-8154

Specialties & licenses 1

Addresses

Other names 1

• Laboratorio clinico Divino Nino Former legal business name

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": "1401667200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1401667200000",
    "number": "1457763997",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 987",
            "city": "MOCA",
            "state": "PR",
            "postal_code": "006760987",
            "telephone_number": "787-551-7175"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "BO. PLATA CARR. 420 KM 4.4",
            "city": "MOCA",
            "state": "PR",
            "postal_code": "00676",
            "telephone_number": "787-551-7175"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LABORATORIO CLINICO DIVINO NINO, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-02",
        "last_updated": "2014-06-02",
        "status": "A",
        "authorized_official_last_name": "AVILES",
        "authorized_official_first_name": "BRENDALIZ",
        "authorized_official_title_or_position": "SUPERVISOR",
        "authorized_official_telephone_number": "787-635-8154",
        "authorized_official_credential": "M.T."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "PR",
            "license": "1312",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Laboratorio clinico Divino Nino",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Clinical Medical Laboratory in Moca, PR
• Providers in Moca, 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 2, 2014; 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.