1093200024 NPI number — LABORATORIO CLINICO IRIZARRY GUASCH INC

Table of content: DR. GREGORY MICHAEL BURKMAN MD, PHARMD (NPI 1043500341)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093200024 NPI number — LABORATORIO CLINICO IRIZARRY GUASCH INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LABORATORIO CLINICO IRIZARRY GUASCH 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:
Provider Other Organization Name Type Code:
6
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:
1093200024
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/22/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 593
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAJAS
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00667
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-899-7223
Provider Business Mailing Address Fax Number:
787-899-1861

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
222 AVENIDA LOS ATLETICOS DE SAN GERMAN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN GERMAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00683
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-892-0520
Provider Business Practice Location Address Fax Number:
787-264-7009
Provider Enumeration Date:
06/22/2018

Additional Information

Authorized Official

Authorized Official Last Name:
SANTIAGO RODRIGUEZ
Authorized Official First Name:
CYNTHIA
Authorized Official Middle Name:
Authorized Official Title or Position:
SUPERVISORA
Authorized Official Telephone Number:
787-899-7223

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , 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)





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