P.R. Clinical Reference Laboratory Inc

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

558 Issued in PR

Legal business name

P.R. CLINICAL REFERENCE LABORATORY INC

Practice address

Calle JJ Acosta No 46
Vega Baja, PR 00693

Phone

(787) 966-7108

Fax

(787) 680-0183

NPI assigned

May 23, 2005

Last updated

Aug 4, 2023By 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

Mr. Carlos A. Gonzalez

Title

President

Phone

(787) 246-4698

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": "1116806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1691107200000",
    "number": "1932102167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 4605",
            "city": "VEGA BAJA",
            "state": "PR",
            "postal_code": "00694",
            "telephone_number": "787-966-7108",
            "fax_number": "787-680-0183"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "CALLE JJ ACOSTA NO 46",
            "city": "VEGA BAJA",
            "state": "PR",
            "postal_code": "00693",
            "telephone_number": "787-966-7108",
            "fax_number": "787-680-0183"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "P.R. CLINICAL REFERENCE LABORATORY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-05-23",
        "last_updated": "2023-08-04",
        "certification_date": "2023-08-04",
        "status": "A",
        "authorized_official_last_name": "GONZALEZ",
        "authorized_official_first_name": "CARLOS",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "787-246-4698",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "PR",
            "license": "558",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Oscorp CSP
• Carmen M Osorio-Rivera, MD
• Ivonne Damaris Otero Lopez
• Reynaldo Otero Sr., THL
• Tiara Nahir Otero, D.M.D.
• Sullybeth Pabon
• Joann Alyssa Padilla, MD
• Rosa Marie Pagan, PA
• Panriv Medical Services Corp.
• Carlos Josue Pantoja, M.S.

• Clinical Medical Laboratory in Vega Baja, PR
• Providers in Vega Baja, 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 Aug 4, 2023; 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.