1932186855 NPI number — NILSA IVETTE SANCHEZ SHUMATE/LABORATORIO CLINICO MODELO

Table of content: (NPI 1932186855)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932186855 NPI number — NILSA IVETTE SANCHEZ SHUMATE/LABORATORIO CLINICO MODELO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NILSA IVETTE SANCHEZ SHUMATE/LABORATORIO CLINICO MODELO
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:
LABORATORIO CLINICO MODELO
Provider Other Organization Name Type Code:
3
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:
1932186855
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/13/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 598
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CATANO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00963-0598
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-788-1428
Provider Business Mailing Address Fax Number:
787-788-2409

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
170 AVE BARBOSA
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CATANO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00962
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-788-1428
Provider Business Practice Location Address Fax Number:
787-788-2409
Provider Enumeration Date:
12/30/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SANCHEZ SHUMATE
Authorized Official First Name:
NILSA
Authorized Official Middle Name:
I
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
787-788-1428

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  523 , 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: 1000 . This is a "AMERICAN HEALTH MEDICARE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 20141 . This is a "PREFERRED MEDICARE CHOICE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 3-0315 . This is a "SSS, OPTIMO, SELECTO" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 400646 . This is a "PREFERRED HEALTH" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 3-0315 , issued by the state of ( PR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 011-523 . This is a "GLOBAL HEALTH PLAN" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: LA-0244 . This is a "PALIC" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 0794 . This is a "INTERNATIONAL MEDICAL CAR" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 1349 . This is a "APS" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 20200 . This is a "AMERICAN HEALTH" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 800047 . This is a "MMM" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 962-0064 . This is a "HUMANA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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