1841377058 NPI number — TEJAV SANTURCE LAB SERVICES, INC.

Table of content: (NPI 1841377058)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841377058 NPI number — TEJAV SANTURCE LAB SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TEJAV SANTURCE LAB SERVICES, 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:
1841377058
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/15/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 360632
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:
00936-0632
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-763-3545
Provider Business Mailing Address Fax Number:
787-724-0545

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1427 AVE FERNANDEZ JUNCOS
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00909-2658
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-763-3545
Provider Business Practice Location Address Fax Number:
787-724-0545
Provider Enumeration Date:
11/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ORTIZ
Authorized Official First Name:
TERESITA
Authorized Official Middle Name:
Authorized Official Title or Position:
LABORATORY DIRECTOR PRESIDENT
Authorized Official Telephone Number:
787-763-3545

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  00910 , 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: 31573 . This is a "SSS" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 9270028 . This is a "HUMANA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: LA-0267 . This is a "PALIC" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 00910 . This is a "HEALTH DEPARTMENT" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 400166 . This is a "PREFERED HEALTH" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 51238 . This is a "CRUZ AZUL" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 40D0922572 . This is a "CLIA" identifier . This identifiers is of the category "OTHER".
  • Identifier: B634 . This is a "IMC" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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