Laboratorio Clinico del Bo. Corcobada, Inc.

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

1007 Issued in PR

Legal business name

LABORATORIO CLINICO DEL BO. CORCOBADA, INC.

Practice address

493 Rd K.M. 4.2 Corcovado WD
Hatillo, PR 00659

Phone

(787) 820-7402

Fax

(787) 820-7402

NPI assigned

Mar 20, 2007

Last updated

Dec 16, 2014By 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

Robindranath Perez, M.T.

Title

President

Phone

(787) 820-7402

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in PR

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Robindranath Perez Diaz, M.T.

  • Clinical Medical Laboratory
  • Hatillo, PR
  • NPI 1295859783
  NPD (past)

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

{
    "created_epoch": "1174348800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1418688000000",
    "number": "1679698542",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 140267",
            "city": "ARECIBO",
            "state": "PR",
            "postal_code": "006140267",
            "telephone_number": "787-820-7402",
            "fax_number": "787-820-7402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "493 RD K.M. 4.2 CORCOVADO WD",
            "city": "HATILLO",
            "state": "PR",
            "postal_code": "00659",
            "telephone_number": "787-820-7402",
            "fax_number": "787-820-7402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LABORATORIO CLINICO DEL BO. CORCOBADA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-20",
        "last_updated": "2014-12-16",
        "status": "A",
        "authorized_official_last_name": "PEREZ",
        "authorized_official_first_name": "ROBINDRANATH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "787-820-7402",
        "authorized_official_credential": "M.T."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "PR",
            "license": "1007",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA NUMBER",
            "identifier": "40D0967204",
            "state": "PR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• La Vida Medical Group Hatillo PT
• La Vida Medical Group PSC
• Lab Clinico CDT Dr Ferdinando Maldonado
• Laboratorio Clinic Omaris Inc
• Laboratorio Clinic Omaris, Inc (Laboratorio Clinico y Bacteriologico Omarys)
• Laboratorio Clinico El Cemi
• Laboratorio Clinico Hatillano
• Laboratorio Clinico Plaza del Norte Inc.
• Laboratorios del Sueno de Puerto Rico
• Laborotorio Clinico Y Bacteriologico Hatillo Inc

• Clinical Medical Laboratory in Hatillo, PR
• Providers in Hatillo, 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 Dec 16, 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.