Dorado Medical Complex Laboratory

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

1122 Issued in PR

Legal business name

DORADO MEDICAL COMPLEX LABORATORY

Practice address

Calle Mendez Vigo 349 Suite 10
Dorado, PUERTO RICO 00646
UM

Phone

(787) 278-1576

Fax

(787) 278-1576

NPI assigned

Dec 2, 2015

Last updated

Sep 28, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Johnny Ongay Rullan, MD

Title

President

Phone

(787) 278-1576

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

CDT Dorado Medical Complex Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• CDT Dorado Medical Complex Inc

  • Clinic Pharmacy
  • Dorado, PR
  • NPI 1497807473
  NPD tax ID
• CDT Dorado Medical Complex, Inc.

  • Emergency Care Clinic/Center
  • Dorado, PR
  • NPI 1386794857
  NPD tax ID

Locations

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

{
    "created_epoch": "1449014400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1569628800000",
    "number": "1609241678",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "349 CALLE MENDEZ VIGO",
            "address_2": "SUITE 10",
            "city": "DORADO",
            "state": "PR",
            "postal_code": "00646",
            "telephone_number": "787-278-1576",
            "fax_number": "787-278-1576"
        },
        {
            "country_code": "UM",
            "country_name": "United States Minor Outlying Islands",
            "address_purpose": "LOCATION",
            "address_type": "FGN",
            "address_1": "CALLE MENDEZ VIGO 349 SUITE 10",
            "city": "DORADO",
            "state": "PUERTO RICO",
            "postal_code": "00646",
            "telephone_number": "787-278-1576",
            "fax_number": "787-278-1576"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DORADO MEDICAL COMPLEX LABORATORY",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-02",
        "last_updated": "2019-09-28",
        "status": "A",
        "authorized_official_last_name": "ONGAY RULLAN",
        "authorized_official_first_name": "JOHNNY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "787-278-1576",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "PR",
            "license": "1122",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LIC 35",
            "identifier": "40D0992077",
            "state": "PR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.