Laboratorio Clinico Plaza Encantada Inc

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

1083 Issued in PR

Legal business name

LABORATORIO CLINICO PLAZA ENCANTADA INC

Practice address

Carr 181 C4 Ave Encantada
Trujillo Alto, PR 00976

Phone

(787) 748-3010

Fax

(787) 748-3011

NPI assigned

Nov 2, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Miguel A Rodriguez, LCDO

Title

Owner

Phone

(787) 748-3010

Specialties & licenses 1

Addresses

Other identifiers 1

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": "1193961600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1205452800000",
    "number": "1538348875",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "CARR 181 C4 AVE ENCANTADA",
            "city": "TRUJILLO ALTO",
            "state": "PR",
            "postal_code": "00976",
            "telephone_number": "787-748-3010",
            "fax_number": "787-748-3011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "CARR 181 C4 AVE ENCANTADA",
            "city": "TRUJILLO ALTO",
            "state": "PR",
            "postal_code": "00976",
            "telephone_number": "787-748-3010",
            "fax_number": "787-748-3011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LABORATORIO CLINICO PLAZA ENCANTADA INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-02",
        "last_updated": "2008-03-14",
        "status": "A",
        "authorized_official_last_name": "RODRIGUEZ",
        "authorized_official_first_name": "MIGUEL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "787-748-3010",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LCDO"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "PR",
            "license": "1083",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH DEPARTMENT LICENSE",
            "identifier": "1083",
            "state": "PR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Knowledge to Manage Change LLC
• Gabriel La Santa, PHARMD
• Laboratorio Ciudad Universitaria LLC
• Laboratorio Clinico Ebenezer LLC
• Laboratorio Clinico Fair View CSP
• Laboratorio Clinico Rural Trujillo Alto
• Laboratorio Clinico Santa Cruz Corp.
• Laboratorio Clinico Trujillano Inc
• Laboratorio Clinico Trujillo Alto
• Laboratorio Matienzo Inc.

• 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 Mar 14, 2008; 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.