1043283971 NPI number — LAS LOMAS LABORATORY INC.

Table of content: (NPI 1043283971)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043283971 NPI number — LAS LOMAS LABORATORY INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAS LOMAS LABORATORY INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LAB. CLINICO LAS LOMAS
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043283971
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/20/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 367027
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00936-7027
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-792-1824
Provider Business Mailing Address Fax Number:
787-783-6350

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
AVE. JESUS T PINERO ESQ. AVE. SAN PATRICIO LOCAL 32
Provider Second Line Business Practice Location Address:
LAS LOMAS PROFESIONAL CENTER
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00921-1489
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-792-1824
Provider Business Practice Location Address Fax Number:
787-783-6350
Provider Enumeration Date:
02/10/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LOPEZ-LOPEZ
Authorized Official First Name:
WILSON
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENTE
Authorized Official Telephone Number:
787-792-1824

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  374 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 400309 . This is a "UTI PREFERRED HEALTH PLAN" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 31498 . This is a "TRIPLE S" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 6578 . This is a "INTERNATIONAL MEDICAL CAR" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 051822 . This is a "LA CRUZ AZUL PR" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 800313 . This is a "MEDICARE Y MUCHO MAS" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 9210002 . This is a "HUMANA INSURANCE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: LA0304 . This is a "PANAMERICAN LIFE INS" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: LB374 . This is a "UIA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".