Laboratorio Clinico Ebenezer LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

LABORATORIO CLINICO EBENEZER LLC

Practice address

PR 8860 KM 1.2
Plaza Matienzo Bo Cuevas
Trujillo Alto, PR 00976

Phone

(787) 233-1313

NPI assigned

Mar 20, 2019

Organization subpart

No

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

Authorized official

Name

Ms. Enilda Velazquez, PB MT, MLS (ASCP)NPI 1730646142

Title

Owner

Phone

(787) 233-1313

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.

• Enilda Velazquez, PB MT, MLS (ASCP)

  • Clinical Medical Laboratory
  • Trujillo Alto, PR
  • NPI 1730646142
  NPD Authorized official

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

{
    "created_epoch": "1553040000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1553040000000",
    "number": "1972063618",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2C25 AVE C",
            "city": "CAROLINA",
            "state": "PR",
            "postal_code": "009877481",
            "telephone_number": "787-220-1558"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "PR 8860 KM 1.2",
            "address_2": "PLAZA MATIENZO BO CUEVAS",
            "city": "TRUJILLO ALTO",
            "state": "PR",
            "postal_code": "00976",
            "telephone_number": "787-233-1313"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LABORATORIO CLINICO EBENEZER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-03-20",
        "last_updated": "2019-03-20",
        "status": "A",
        "authorized_official_last_name": "VELAZQUEZ",
        "authorized_official_first_name": "ENILDA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "787-233-1313",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "PB MT, MLS (ASCP)"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1255788386",
            "state": "PR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Gabriel La Santa, PHARMD
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• Laboratorio Clinico Fair View CSP
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• Laboratorio Clinico Rural Trujillo Alto
• Laboratorio Clinico Santa Cruz Corp.
• Laboratorio Clinico Trujillano 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 20, 2019; 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.