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LABORATORIO CLINICO PLAZA REAL INC
Complete NPI Record 1639169006
Clinical Medical Laboratory in Guaynabo, PR

NPI Status: Active since October 26, 2005

Contact Information

1 AVE ARBOLOTE
SUITE 302 PLAZA REAL MALL
GUAYNABO, PR
ZIP 00969
Phone: (787) 720-1444
Fax: (787) 963-0446

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Table of Contents

  1. NPI
  2. Entity Type Code
  3. Employer Identification Number EIN
  4. Provider Organization Name Legal Business Name
  5. Provider First Line Business Mailing Address
  6. Provider Second Line Business Mailing Address
  7. Provider Business Mailing Address City Name
  8. Provider Business Mailing Address State Name
  9. Provider Business Mailing Address Postal Code
  10. Provider Business Mailing Address Country Code If outside U S
  11. Provider Business Mailing Address Telephone Number
  12. Provider Business Mailing Address Fax Number
  13. Provider First Line Business Practice Location Address
  14. Provider Second Line Business Practice Location Address
  15. Provider Business Practice Location Address City Name
  16. Provider Business Practice Location Address State Name
  17. Provider Business Practice Location Address Postal Code
  18. Provider Business Practice Location Address Country Code If outside U S
  19. Provider Business Practice Location Address Telephone Number
  20. Provider Business Practice Location Address Fax Number
  21. Provider Enumeration Date
  22. Last Update Date
  23. Authorized Official Last Name
  24. Authorized Official First Name
  25. Authorized Official Middle Name
  26. Authorized Official Title or Position
  27. Authorized Official Telephone Number
  28. Healthcare Provider Taxonomy Code 1
  29. Provider License Number 1
  30. Provider License Number State Code 1
  31. Healthcare Provider Primary Taxonomy Switch 1
  32. Other Provider Identifier 1
  33. Other Provider Identifier Type Code 1
  34. Other Provider Identifier State 1
  35. Other Provider Identifier Issuer 1
  36. Other Provider Identifier 2
  37. Other Provider Identifier Type Code 2
  38. Other Provider Identifier State 2
  39. Other Provider Identifier Issuer 2
  40. Other Provider Identifier 3
  41. Other Provider Identifier Type Code 3
  42. Other Provider Identifier State 3
  43. Other Provider Identifier Issuer 3
  44. Other Provider Identifier 4
  45. Other Provider Identifier Type Code 4
  46. Other Provider Identifier State 4
  47. Other Provider Identifier Issuer 4
  48. Other Provider Identifier 5
  49. Other Provider Identifier Type Code 5
  50. Other Provider Identifier State 5
  51. Other Provider Identifier Issuer 5
  52. Other Provider Identifier 6
  53. Other Provider Identifier Type Code 6
  54. Other Provider Identifier State 6
  55. Other Provider Identifier Issuer 6
  56. Other Provider Identifier 7
  57. Other Provider Identifier Type Code 7
  58. Other Provider Identifier State 7
  59. Other Provider Identifier Issuer 7
  60. Other Provider Identifier 8
  61. Other Provider Identifier Type Code 8
  62. Other Provider Identifier State 8
  63. Other Provider Identifier Issuer 8
  64. Other Provider Identifier 9
  65. Other Provider Identifier Type Code 9
  66. Other Provider Identifier State 9
  67. Other Provider Identifier Issuer 9
  68. Other Provider Identifier 10
  69. Other Provider Identifier Type Code 10
  70. Other Provider Identifier State 10
  71. Other Provider Identifier Issuer 10
  72. Other Provider Identifier 11
  73. Other Provider Identifier Type Code 11
  74. Other Provider Identifier State 11
  75. Other Provider Identifier Issuer 11
  76. Other Provider Identifier 12
  77. Other Provider Identifier Type Code 12
  78. Other Provider Identifier State 12
  79. Other Provider Identifier Issuer 12
  80. Other Provider Identifier 13
  81. Other Provider Identifier Type Code 13
  82. Other Provider Identifier State 13
  83. Other Provider Identifier Issuer 13
  84. Other Provider Identifier 14
  85. Other Provider Identifier Type Code 14
  86. Other Provider Identifier State 14
  87. Other Provider Identifier Issuer 14
  88. Other Provider Identifier 15
  89. Other Provider Identifier Type Code 15
  90. Other Provider Identifier State 15
  91. Other Provider Identifier Issuer 15
  92. Is Organization Subpart
  93. Authorized Official Name Prefix Text

Complete NPI Dataset

This page represents the complete record for NPI 1639169006. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1639169006
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Entity Type Code: 2
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Employer Identification Number EIN: UNAVAIL
The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
The name of the organization provider. If the provider is an organization, this is the legal business name.
Provider First Line Business Mailing Address: 1 AVE ARBOLOTE
The first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Second Line Business Mailing Address: SUITE 302 PLAZA REAL MALL
The second line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider second line location address’’.
Provider Business Mailing Address City Name: GUAYNABO
The city name in the mailing address of the provider being identified.
Provider Business Mailing Address State Name: PR
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Postal Code: 009692806
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Country Code If outside U S : US
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address Telephone Number: 7877201444
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider Business Mailing Address Fax Number: 7879630446
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address fax number’’.
Provider First Line Business Practice Location Address: 1 AVE ARBOLOTE
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Second Line Business Practice Location Address: SUITE 302 PLAZA REAL MALL
The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name: GUAYNABO
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name: PR
The State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code: 009692806
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S : US
The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number: 7877201444
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number: 7879630446
The fax number associated with the location address of the provider being identified.
Provider Enumeration Date: 10/26/2005
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 11/1/2011
The date that a record was last updated or changed.
Authorized Official Last Name: SANTIAGO
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First Name: RAFAEL
The first name of the authorized official.
Authorized Official Middle Name: E
The middle name of the authorized official.
Authorized Official Title or Position: ADMINISTRATOR
The title or position of the authorized official.
Authorized Official Telephone Number: 7877201444
The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code 1: 291U00000X
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Provider License Number 1: 702
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 1: PR
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 1: Y
Other Provider Identifier 1: =========
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 1: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 1: PR
Other Provider Identifier Issuer 1: ORG. SALUD ADMINISTRADA
Other Provider Identifier 2: 20213
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 2: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 2: PR
Other Provider Identifier Issuer 2: AMERICAN HEALTH
Other Provider Identifier 3: =========
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 3: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 3: PR
Other Provider Identifier Issuer 3: MCS PROVIDER NUMBER
Other Provider Identifier 4: 30716
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 4: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 4: PR
Other Provider Identifier Issuer 4: SSS
Other Provider Identifier 5: =========
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 5: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 5: PR
Other Provider Identifier Issuer 5: OPTIONS HEALTH PLAN
Other Provider Identifier 6: 051307
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 6: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 6: PR
Other Provider Identifier Issuer 6: CRUZ AZUL DE PR
Other Provider Identifier 7: 20278
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 7: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 7: PR
Other Provider Identifier Issuer 7: PREFERRED MEDICAL CHOICE
Other Provider Identifier 8: =========
The code designating the provider’s gender if the provider is a person.
Other Provider Identifier Type Code 8: 01
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Other Provider Identifier State 8: PR
Other Provider Identifier Issuer 8: MAPFRE
Other Provider Identifier 9: =========
Other Provider Identifier Type Code 9: 01
Other Provider Identifier State 9: PR
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Other Provider Identifier Issuer 9: COSVI
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Other Provider Identifier 10: L-400141
Other Provider Identifier Type Code 10: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 10: PR
Other Provider Identifier Issuer 10: PREFERRED HEALTH PLAN
Other Provider Identifier 11: 1271
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 11: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 11: PR
Other Provider Identifier Issuer 11: INTERNATIONAL MEDICAL CAR
Other Provider Identifier 12: 800220
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 12: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 12: PR
Other Provider Identifier Issuer 12: MMM PROVIDER NUMBER
Other Provider Identifier 13: =========
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 13: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 13: PR
Other Provider Identifier Issuer 13: CIGNA PROVIDER NUMBER
Other Provider Identifier 14: 6570083
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 14: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 14: PR
Other Provider Identifier Issuer 14: HUMANA
Other Provider Identifier 15: =========
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 15: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 15: PR
Other Provider Identifier Issuer 15: FIRST PLUS
Is Organization Subpart: N
Authorized Official Name Prefix Text: MR.