Laboratorio Clinico Minillas Corp.

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

1260 Issued in PR

Legal business name

LABORATORIO CLINICO MINILLAS CORP.

Practice address

Minillas CT
NM 14 Santa Juanita
Bayamon, PR 00956-5359

Phone

(787) 269-5262

Fax

(787) 798-3853

NPI assigned

Jan 6, 2011

Organization subpart

No

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

Authorized official

Name

Mrs. Wanda Ivelisse Roman, MA.ED.

Title

President

Phone

(787) 941-7264

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in PR

Enrollment records 1

Locations

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

{
    "created_epoch": "1294272000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1657843200000",
    "number": "1780988659",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "NH31 CAMINO DE VELARDE",
            "address_2": "MANSION DEL NORTE",
            "city": "TOA BAJA",
            "state": "PR",
            "postal_code": "009494839",
            "telephone_number": "787-784-7897"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "MINILLAS CT",
            "address_2": "NM 14 SANTA JUANITA",
            "city": "BAYAMON",
            "state": "PR",
            "postal_code": "009565359",
            "telephone_number": "787-269-5262",
            "fax_number": "787-798-3853"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LABORATORIO CLINICO MINILLAS CORP.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-06",
        "last_updated": "2022-07-15",
        "certification_date": "2022-07-15",
        "status": "A",
        "authorized_official_last_name": "ROMAN",
        "authorized_official_first_name": "WANDA",
        "authorized_official_middle_name": "IVELISSE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "787-941-7264",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MA.ED."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "PR",
            "license": "1260",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Medical Laboratory in Bayamon, PR
• Providers in Bayamon, 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 Jul 15, 2022; 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.